title: Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma.
abstract: BACKGROUND
  Pancreatic fistula (PF) is a common complication after pancreatectomy. Previous reports indicate that preoperative irradiation decreases the risk of PF after pancreatoduodenectomy. In this context, the impact of preoperative chemoradiation therapy (CRT) on PF formation after distal pancreatectomy is of interest.
  
  
  METHODS
  Fifty-eight patients with pancreatic adenocarcinoma who underwent distal pancreatectomy, including 28 patients with preoperative gemcitabine-based CRT and 30 patients without preoperative treatment, were assessed in this study. The incidence and severity of postoperative PF, assessed according to the definition of the International Study Group on Pancreatic Fistula, were compared between the 2 groups.
  
  
  RESULTS
  In the CRT group, 86% of patients did not develop PF, whereas grades A and B PF were observed in 1 and 3 patients, respectively. In the non-CRT group, 33% of patients did not develop a PF, whereas grades A and B PF were observed in 9 and 11 patients, respectively. The incidence of clinically significant PF, defined as either grade B or grade C PF, was less in the CRT group (P = .031). The amylase activities in the draining fluid on postoperative days 1 and 3 were both less in the CRT group (P = .003 and P = .006, respectively).
  
  
  CONCLUSIONS
  Preoperative CRT significantly decreases the incidence of PF after distal pancreatectomy, which potentially provides another benefit to patients in addition to its original advantages (ie, locoregional effect and patient selection effect), allowing more opportunities for the immediate initiation of postoperative adjuvant treatment.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. takahasi-hi@mc.pref.osaka.jp
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hisataka
authors.initials: H
authors.lastname: Ogawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Kunihito
authors.initials: K
authors.lastname: Gotoh
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Shingai
authors.forename: Satoaki
authors.initials: S
authors.lastname: Nakamura
authors.forename: Kinji
authors.initials: K
authors.lastname: Nishiyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D001707:Biopsy, Needle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome