title: Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer.
abstract: OBJECTIVE
  The results of surgical therapy alone for pancreatic cancer are disappointing. We explored surgical results after neoadjuvant chemoradiation therapy (NACRT) for patients with pancreatic cancer that extended beyond the pancreas.
  
  
  METHODS
  Sixty-eight consecutive patients with pancreatic cancer who underwent pancreatic resection were included. Twenty-seven patients underwent surgical resection after NACRT (NACRT group). The other 41 patients were classified as surgery-alone group. Surgical results were compared in patients who underwent curative resection (R0/1) who were followed up for at least 25 months and underwent no adjuvant therapy.
  
  
  RESULTS
  A lower frequency of lymph node metastasis was observed in the NACRT group (P < 0.05). The frequency of residual tumor grading in the NACRT group was significantly different from that in surgery-alone (R0/1/2%, 52/15/33 vs 22/51/27; P = 0.0040). In R0/1 cases, overall survival and disease-free survival rates in the NACRT group (n = 18) were significantly longer than in surgery-alone (n = 30, P < 0.05). The rate of local recurrence in the NACRT group was significantly less than in surgery-alone (11% vs 47%, P = 0.0024).
  
  
  CONCLUSIONS
  This single-institution experience indicates that NACRT is able to increase the resectability rate with clear margins and to decrease the rate of metastatic lymph nodes, resulting in improved prognosis of curative cases with pancreatic cancer that extended beyond the pancreas.
authors.affiliation: Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan. satoi@hirakata.kmu.ac.jp
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Kanji
authors.initials: K
authors.lastname: Takahashi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitade
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.forename: Noboru
authors.initials: N
authors.lastname: Tanigawa
authors.forename: Soichiro
authors.initials: S
authors.lastname: Takai
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008207:Lymphatic Metastasis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine