title: A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer.
abstract: BACKGROUND
  This systematic review and meta-analysis aims to characterize the surgically important benefits and complications associated with the use of neoadjuvant chemoradiotherapy for the treatment of both resectable and initially unresectable pancreatic cancer. Studies were identified through a systematic literature search and analyzed by two independent reviewers. Survival, peri-operative complications, death rate, pancreatic fistula rate, and the incidence of involved surgical margins were analyzed and subject to meta-analysis.
  
  
  METHODS
  Nineteen studies, involving 2,148 patients were identified. Only cohort studies were included.
  
  
  RESULTS
  The meta-analysis found that patients with unresectable pancreatic cancer who underwent neoadjuvant chemoradiotherapy achieved similar survival outcomes to patients with resectable disease, even though only 40% were ultimately resected. Neoadjuvant chemoradiotherapy was not associated with a statistically significant increase in the rate of pancreatic fistula formation or total complications.
  
  
  CONCLUSIONS
  Patients receiving neoadjuvant chemoradiotherapy were less likely to have a positive resection margin, although there was an increase in the risk of peri-operative death.
authors.affiliation: Department of Surgery, University of Sydney, Blackburn Building D06, Sydney, NSW, 2006, Australia. jm_laurence@yahoo.co.uk
authors.forename: Jerome Martin
authors.initials: JM
authors.lastname: Laurence
authors.forename: Peter Duy
authors.initials: PD
authors.lastname: Tran
authors.forename: Kavita
authors.initials: K
authors.lastname: Morarji
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
authors.forename: Vincent Wai To
authors.initials: VW
authors.lastname: Lam
authors.forename: Charbel
authors.initials: C
authors.lastname: Sandroussi
mesh_terms: D002277:Carcinoma / Q000401:mortality* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D006801:Humans; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis