• Hidenori Takahashi, Hisataka Ogawa, Hiroaki Ohigashi, Kunihito Gotoh, Terumasa Yamada, Masayuki Ohue, Isao Miyashiro, Shingo Noura, Kentaro Kishi, Masaaki Motoori, Tatsushi Shingai, Satoaki Nakamura, Kinji Nishiyama, Masahiko Yano, and Osamu Ishikawa.
• Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. takahasi-hi@mc.pref.osaka.jp
• Surgery. 2011 Sep 1; 150 (3): 547-56.

BackgroundPancreatic fistula (PF) is a common complication after pancreatectomy. Previous reports indicate that preoperative irradiation decreases the risk of PF after pancreatoduodenectomy. In this context, the impact of preoperative chemoradiation therapy (CRT) on PF formation after distal pancreatectomy is of interest.MethodsFifty-eight patients with pancreatic adenocarcinoma who underwent distal pancreatectomy, including 28 patients with preoperative gemcitabine-based CRT and 30 patients without preoperative treatment, were assessed in this study. The incidence and severity of postoperative PF, assessed according to the definition of the International Study Group on Pancreatic Fistula, were compared between the 2 groups.ResultsIn the CRT group, 86% of patients did not develop PF, whereas grades A and B PF were observed in 1 and 3 patients, respectively. In the non-CRT group, 33% of patients did not develop a PF, whereas grades A and B PF were observed in 9 and 11 patients, respectively. The incidence of clinically significant PF, defined as either grade B or grade C PF, was less in the CRT group (P = .031). The amylase activities in the draining fluid on postoperative days 1 and 3 were both less in the CRT group (P = .003 and P = .006, respectively).ConclusionPreoperative CRT significantly decreases the incidence of PF after distal pancreatectomy, which potentially provides another benefit to patients in addition to its original advantages (ie, locoregional effect and patient selection effect), allowing more opportunities for the immediate initiation of postoperative adjuvant treatment.Copyright © 2011 Mosby, Inc. All rights reserved.

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