title: Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer.
abstract: OBJECTIVE
  To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma.
  
  
  METHODS
  One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retroperitoneal dissection was performed directly along the superior mesenteric artery in all cases. A standard histopathologic protocol that measured the "superior mesenteric artery (SMA) margin distance" between cancer cells and the superior mesenteric artery was employed.
  
  
  RESULTS
  Seventy-six percent of patients received neoadjuvant chemoradiation. The SMA margin was positive in 4% of patients but an additional 22% of patients with a negative margin had a SMA margin distance of ≤1 mm. Preoperative CT images overestimated the SMA margin distance in 73% of cases. Patients who received chemoradiation had longer SMA margin distances than those who did not. Patients who received chemoradiation and had a SMA margin of >1 mm had the lowest recurrence rates. Administration of neoadjuvant chemoradiation and lower estimated blood loss were independently associated with longer progression-free survival on multivariate analysis.
  
  
  CONCLUSIONS
  Preoperative chemoradiation and meticulous dissection of the superior mesenteric artery maximize the distance between cancer cells and the SMA margin and may influence locoregional control.
authors: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA. mhgkatz@mdanderson.org
authors: Matthew H G
authors: MH
authors: Katz
authors: Huamin
authors: H
authors: Wang
authors: Aparna
authors: A
authors: Balachandran
authors: Priya
authors: P
authors: Bhosale
authors: Christopher H
authors: CH
authors: Crane
authors: Xuemei
authors: X
authors: Wang
authors: Peter W T
authors: PW
authors: Pisters
authors: Jeffrey E
authors: JE
authors: Lee
authors: Jean-Nicolas
authors: JN
authors: Vauthey
authors: Eddie K
authors: EK
authors: Abdalla
authors: Robert
authors: R
authors: Wolff
authors: James
authors: J
authors: Abbruzzese
authors: Gauri
authors: G
authors: Varadhachary
authors: Xavier
authors: X
authors: Chopin-Laly
authors: Chusilp
authors: C
authors: Charnsangavej
authors: Jason B
authors: JB
authors: Fleming
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D000069287:Capecitabine; D059186:Chemoradiotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D004210:Dissection; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil; D000093542:Gemcitabine