Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy.
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.
Cheng
Tsung-Yen
TY
Department of Surgery, Duke University Medical Center, Box 3118, Durham, North Carolina 27710, USA.
Sheth
Ketan
K
White
Rebekah R
RR
Ueno
Tomio
T
Hung
Cheng-Fang
CF
Clary
Bryan M
BM
Pappas
Theodore N
TN
Tyler
Douglas S
DS
D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000401:mortality; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome
D005472:Fluorouracil