title: Intraoperative radiation therapy following pancreaticoduodenectomy.
abstract: OBJECTIVE
  To determine the morbidity and mortality of pancreaticoduodenectomy followed by electron-beam intraoperative radiation therapy (EB-IORT).
  
  
  BACKGROUND
  Local recurrence following pancreaticoduodenectomy occurs in 50% to 90% of patients who undergo a potentially curative surgical resection for adenocarcinoma of the pancreatic head. To improve local disease control, a more aggressive retroperitoneal dissection has been combined with adjuvant EB-IORT.
  
  
  METHODS
  Forty-one patients with malignant neoplasms of the periampullary region underwent pancreaticoduodenectomy followed by EB-IORT between January 1989 and May 1992. EB-IORT was delivered in a dedicated operative suite, eliminating the need for patient relocation. Electron-beam energies of 6 to 12 MeV were used to deliver 10 to 20 Gy to the treatment field following resection but before pancreatic, biliary, and gastrointestinal reconstruction.
  
  
  RESULTS
  Median operative time was 9 hours, blood loss was 1 L, perioperative transfusion requirement was 2 units, and hospital stay was 20 days. One patient died of a postoperative myocardial infarction, and four patients required reoperation, one for an anastomotic leak. No patient failed to receive EB-IORT because of operative complications during the time period of this study.
  
  
  CONCLUSIONS
  Adjuvant EB-IORT after pancreaticoduodenectomy can be delivered safely, with low mortality and acceptable morbidity.
authors.affiliation: Department of Surgical Oncology, University of Texas, M.D. Anderson Cancer Center, Houston.
authors.forename: D B
authors.initials: DB
authors.lastname: Evans
authors.forename: P M
authors.initials: PM
authors.lastname: Termuhlen
authors.forename: D R
authors.initials: DR
authors.lastname: Byrd
authors.forename: F C
authors.initials: FC
authors.lastname: Ames
authors.forename: T G
authors.initials: TG
authors.lastname: Ochran
authors.forename: T A
authors.initials: TA
authors.lastname: Rich
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000401:mortality; D011859:Radiography