title: Neoadjuvant therapy and vascular resection during pancreaticoduodenectomy: shifting the survival curve for patients with locally advanced pancreatic cancer.
abstract: BACKGROUND
  Neoadjuvant therapy and vascular resection may offer patients with locally advanced pancreatic cancer potential cure.
  
  
  METHODS
  We reviewed medical records of patients with ductal adenocarcinoma who underwent pancreaticoduodenectomy (PD) from 1992 through 2011. We identified patients who received neoadjuvant therapy (NA+) or required vascular resection (VR+) for locally advanced disease and compared outcomes to those who did not.
  
  
  RESULTS
  Of the 643 patients who were initially explored, 506 (143 NA+ and 363 NA- patients) ultimately underwent PD. There were no significant differences in R0 resection or morbidity. Mortality was higher in the NA+ versus NA- group (7.0 vs 3.0 %, p = 0.04). More NA+ patients underwent PD VR+ (p < 0.001). Among VR+ patients, neoadjuvant therapy resulted in significantly lower R1 resection. Among resected patients, survival of NA+ patients was significantly longer than both NA- patients (27.3 vs 19.7 months, p < 0.05) and patients abandoned because of locally advanced disease. Age, tumor grade, lymph node ratio, and R1 resection were independent predictors of poor survival.
  
  
  CONCLUSIONS
  Neoadjuvant therapy and vascular resection offer patients with locally advanced pancreatic cancer the chance for cure with acceptable morbidity and mortality. These patients have improved survival over patients deemed locally inoperable by traditional criteria.
authors.affiliation: Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA, irene.epelboym@gmail.com.
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.forename: J
authors.initials: J
authors.lastname: DiNorcia
authors.forename: M
authors.initials: M
authors.lastname: Winner
authors.forename: M K
authors.initials: MK
authors.lastname: Lee
authors.forename: J A
authors.initials: JA
authors.lastname: Lee
authors.forename: B A
authors.initials: BA
authors.lastname: Schrope
authors.forename: J A
authors.initials: JA
authors.lastname: Chabot
authors.forename: J D
authors.initials: JD
authors.lastname: Allendorf
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D014656:Vascular Surgical Procedures