title: Does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates?
abstract: BACKGROUND
  The impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
  
  
  METHODS
  Data from the NSQIP Pancreatectomy Demonstration Project (11/2011 to 12/2012) was used to identify patients with pancreatic adenocarcinoma who did and did not receive neoadjuvant therapy. Neoadjuvant therapy was classified as chemotherapy alone or radiation ± chemotherapy. Outcomes in the neoadjuvant vs. surgery first groups were compared.
  
  
  RESULTS
  Of 1,562 patients identified at 43 hospitals, 199 (12.7%) received neoadjuvant therapy (99 chemotherapy alone and 100 radiation ± chemotherapy). Preoperative biliary stenting (57.9 vs. 44.7%, p = 0.0005), vascular resection (41.5 vs. 17.3%, p < 0.0001), and open resections (94.0 vs. 91.4%, p = 0.008) were more common in the neoadjuvant group. Thirty-day mortality (2.0 vs. 1.5%, p = 0.56) and postoperative morbidity rates (56.3 vs. 52.8%, p = 0.35) were similar between groups. Neoadjuvant therapy patients had fewer organ space infections (3.0 vs. 10.3%, p = 0.001), and neoadjuvant radiation patients had fewer pancreatic fistulas (7.3 vs. 15.4%, p = 0.03).
  
  
  CONCLUSIONS
  Despite evidence for more extensive disease, patients receiving neoadjuvant therapy did not experience more complications. Neoadjuvant radiation was associated with lower pancreatic fistula rates. These data provide evidence against higher postoperative complication rates in patients with pancreatic cancer who are treated with neoadjuvant therapy.
authors.affiliation: Department of Surgery, Penn State Hershey, Hershey, PA, USA.
authors.forename: Amanda B
authors.initials: AB
authors.lastname: Cooper
authors.forename: Abhishek D
authors.initials: AD
authors.lastname: Parmar
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D011184:Postoperative Period; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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