title: Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy?
abstract: BACKGROUND
  Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as initial treatment for pancreatic adenocarcinoma. This study reexamined the frequency of delayed recovery and assessed other factors associated with adjuvant therapy administration after PD at a high-volume center.
  
  
  METHODS
  Preoperative and perioperative variables were reviewed in a consecutive series of 85 patients with pancreatic adenocarcinoma undergoing PD without preoperative chemotherapy or radiotherapy from 1990 to 2004.
  
  
  RESULTS
  Study groups included patients undergoing emergency PD (group 1, n=13); elective PD with good preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) (group 2, ECOG PS: 0 to 1, n=63); and elective PD with marginal preoperative PS (group 3, ECOG PS: 2 to 3, n=9). Delayed recovery of PS precluded adjuvant therapy in 23% of patients in group 1, 6% of patients in group 2, and 44% of patients in group 3 (p=0.0001).
  
  
  CONCLUSIONS
  The impact of delayed recovery after PD on the delivery of adjuvant therapy depends on the urgency of surgery and the preoperative PS. For patients with good preoperative PS who undergo elective PD at a high-volume center, it is uncommon for delayed recovery to preclude delivery of adjuvant therapy.
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1402, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Aloia
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Gauri R
authors.initials: GR
authors.lastname: Varadhachary
authors.forename: James L
authors.initials: JL
authors.lastname: Abbruzzese
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents