Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: Analysis of perioperative outcome and survival

Paolo Massucco, Lorenzo Capussotti, Antonella Magnino, Elisa Sperti, Marco Gatti, Andrea Muratore, Enrico Sgotto, Pietro Gabriele, Massimo Aglietta

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background: The most accepted treatment for locally advanced pancreatic cancer is chemoradiotherapy. However, indications to and results of pancreatic resections after chemoradiation are not yet defined. Methods: From June 1999 to December 2003, 28 patients with locally advanced pancreatic cancer (group 1) were enrolled for institutional trials of gemcitabine-based chemoradiotherapy. Tumors were stratified as unresectable or borderline resectable according to the pattern of vascular involvement at pretreatment computed tomographic scan. Patients with partial response or stable disease and in-range Ca19-9 were surgically explored. Perioperative outcome and survival of group 1 were compared with 44 patients primary resected for localized cancer with or without adjuvant treatment in the same time period (group 2). Results: Only one unresectable tumor was successfully resected compared to 7 out of 18 (39%) that were borderline resectable. Operations after chemoradiation were 1 hour longer and postoperative stays 5 days longer, but transfusion rate, morbidity, and mortality were not significantly different. Median survival was 15.4 months for group 1 (>21 for resected vs. 10 for not resected, P <0.01) and 14 months for group 2. In both groups, a disease-free survival beyond 24 months was recorded only among patients resected with negative margins. Conclusions: The conversion of an unresectable cancer to a resectable one is a rare event. On the contrary, the resection of a borderline resectable tumor was successfully accomplished in one-third of cases. Chemoradiotherapy did not increase the operative risk, but the interventions were more technically demanding and required a longer postoperative stay. Patients resected after chemoradiation for a locally advanced tumor had at least the same survival as those primary resected for a localized one. Only R0 resections in both groups gave the chance of disease-free survival longer than 24 months. Published by Springer Science+Business Media, Inc.

Original languageEnglish
Pages (from-to)1201-1208
Number of pages8
JournalAnnals of Surgical Oncology
Volume13
Issue number9
DOIs
Publication statusPublished - Sep 2006

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Chemoradiotherapy
Adenocarcinoma
Survival
Neoplasms
gemcitabine
Pancreatic Neoplasms
Disease-Free Survival
Blood Vessels
Morbidity
Mortality
Therapeutics

Keywords

  • Combined modality therapy
  • Locally advanced cancer
  • Pancreatic neoplasm
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma : Analysis of perioperative outcome and survival. / Massucco, Paolo; Capussotti, Lorenzo; Magnino, Antonella; Sperti, Elisa; Gatti, Marco; Muratore, Andrea; Sgotto, Enrico; Gabriele, Pietro; Aglietta, Massimo.

In: Annals of Surgical Oncology, Vol. 13, No. 9, 09.2006, p. 1201-1208.

Research output: Contribution to journalArticle

Massucco, Paolo ; Capussotti, Lorenzo ; Magnino, Antonella ; Sperti, Elisa ; Gatti, Marco ; Muratore, Andrea ; Sgotto, Enrico ; Gabriele, Pietro ; Aglietta, Massimo. / Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma : Analysis of perioperative outcome and survival. In: Annals of Surgical Oncology. 2006 ; Vol. 13, No. 9. pp. 1201-1208.
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T1 - Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma

T2 - Analysis of perioperative outcome and survival

AU - Massucco, Paolo

AU - Capussotti, Lorenzo

AU - Magnino, Antonella

AU - Sperti, Elisa

AU - Gatti, Marco

AU - Muratore, Andrea

AU - Sgotto, Enrico

AU - Gabriele, Pietro

AU - Aglietta, Massimo

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AB - Background: The most accepted treatment for locally advanced pancreatic cancer is chemoradiotherapy. However, indications to and results of pancreatic resections after chemoradiation are not yet defined. Methods: From June 1999 to December 2003, 28 patients with locally advanced pancreatic cancer (group 1) were enrolled for institutional trials of gemcitabine-based chemoradiotherapy. Tumors were stratified as unresectable or borderline resectable according to the pattern of vascular involvement at pretreatment computed tomographic scan. Patients with partial response or stable disease and in-range Ca19-9 were surgically explored. Perioperative outcome and survival of group 1 were compared with 44 patients primary resected for localized cancer with or without adjuvant treatment in the same time period (group 2). Results: Only one unresectable tumor was successfully resected compared to 7 out of 18 (39%) that were borderline resectable. Operations after chemoradiation were 1 hour longer and postoperative stays 5 days longer, but transfusion rate, morbidity, and mortality were not significantly different. Median survival was 15.4 months for group 1 (>21 for resected vs. 10 for not resected, P <0.01) and 14 months for group 2. In both groups, a disease-free survival beyond 24 months was recorded only among patients resected with negative margins. Conclusions: The conversion of an unresectable cancer to a resectable one is a rare event. On the contrary, the resection of a borderline resectable tumor was successfully accomplished in one-third of cases. Chemoradiotherapy did not increase the operative risk, but the interventions were more technically demanding and required a longer postoperative stay. Patients resected after chemoradiation for a locally advanced tumor had at least the same survival as those primary resected for a localized one. Only R0 resections in both groups gave the chance of disease-free survival longer than 24 months. Published by Springer Science+Business Media, Inc.

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KW - Pancreatic neoplasm

KW - Surgery

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