Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy

被引:75
作者
Cheng, TY [1 ]
Sheth, K [1 ]
White, RR [1 ]
Ueno, T [1 ]
Hung, CF [1 ]
Clary, BM [1 ]
Pappas, TN [1 ]
Tyler, DS [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
关键词
pancreaticoduodenectomy; neoadjuvant therapy; morbidity; mortality; pancreatic leak;
D O I
10.1245/ASO.2006.02.003
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Neoadjuvant chemoradiotherapy (neo-CRT) is being used with increasing frequency for periampullary tumors, but how it alters the complication rate of pancreaticoduodenectomy (PD) is unclear. Methods: A retrospective analysis was conducted of 79 patients with periampullary malignancies who received 5-fluorouracil-based neo-CRT followed by PD. Results: There was no difference in mortality between PD after neo-CRT (3.8%) and conventional PD for either malignant (4.5%) or benign (2.2%) disease. Focusing only on patients with malignancy, the neo-CRT group had a significantly lower pancreatic leak rate than the conventional group (10% vs. 43%; P < .001). Intra-abdominal abscesses were less common in the neo-CRT group (8.8% vs. 21%; P = .019), and there was one (1.2%) amylase-rich abscess in neo-CRT group, compared with eight (12%) in the conventional group. In addition, two patients in the conventional group died of leak-associated sepsis, compared with none in the neo-CRT group. Multivariate analysis revealed that neoadjuvant chemoradiation (odds ratio, .15) was the most significant factor associated with a reduced risk of pancreatic leak. Conclusions: Neo-CRT does not increase the mortality or morbidity of PD. In contrast, neo-CRT was associated with a marked reduction in the incidence of pancreatic leak, as well as leak-associated morbidity and mortality.
引用
收藏
页码:66 / 74
页数:9
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