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Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study
- Source :
- Annals of Surgical Oncology, Annals of surgical oncology, 27(6), 1986-1996. Springer New York
- Publication Year :
- 2019
- Publisher :
- Springer International Publishing, 2019.
-
Abstract
- Background Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking. Methods Post hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007–2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test. Results Among 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien–Dindo ≥ 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14–39) versus 31 months (95% CI 19–42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT (n = 37, 14.7%) was associated with prolonged overall survival [36 (95% CI 18–53) versus 20 months (95% CI 15–24), P = 0.049], as compared with upfront resection. Conclusion In this international multicenter cohort study, NAT for resected PDAC in pancreatic body or tail was associated with less morbidity and pancreatic fistula but similar overall survival in comparison with upfront resection. Prospective studies should confirm a survival benefit of NAT in patients with PDAC and splenic vessel involvement.
- Subjects :
- Male
medicine.medical_specialty
Internationality
FOLFIRINOX
medicine.medical_treatment
Leucovorin
Adenocarcinoma
Irinotecan
Gastroenterology
Pancreatic Fistula
Pancreatectomy
Postoperative Complications
Retrospective Studie
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Pancrea
Humans
Prospective cohort study
Propensity Score
Pancreas
Neoadjuvant therapy
Survival analysis
Aged
Retrospective Studies
Antineoplastic Combined Chemotherapy Protocol
business.industry
Pancreatic Neoplasm
Retrospective cohort study
Pancreatic Tumors
Middle Aged
medicine.disease
Survival Analysis
Neoadjuvant Therapy
body regions
Oxaliplatin
Pancreatic Neoplasms
medicine.anatomical_structure
Oncology
Pancreatic fistula
Surgery
Female
Postoperative Complication
Survival Analysi
Fluorouracil
business
Human
Subjects
Details
- Language :
- English
- ISSN :
- 15344681 and 10689265
- Volume :
- 27
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Annals of Surgical Oncology
- Accession number :
- edsair.doi.dedup.....cb1a00595b594bf5282ebc116fb40dd1