title: Perioperative chemotherapy is associated with a survival advantage in early stage adenocarcinoma of the pancreatic head.
abstract: The value of neoadjuvant chemotherapy in the treatment of early stage pancreatic cancer is not yet clear.
  
  
  
  We evaluated patients from the National Cancer Data Base who underwent pancreaticoduodenectomy for clinical stage I and II pancreatic adenocarcinoma between 2006 and 2012.
  
  
  
  In total, 7,881 patients were identified. Of these, 27.5% received no chemotherapy, 57.4% received adjuvant chemotherapy, 10.2% received neoadjuvant chemotherapy alone, and 4.9% received perioperative chemotherapy, both preoperative and postoperative chemotherapy. Neoadjuvant chemotherapy use (neoadjuvant chemotherapy alone and perioperative chemotherapy) increased from 12.0% in 2006 to 20.2% in 2012. Patients who received chemotherapy prior to the operation (neoadjuvant chemotherapy alone and perioperative chemotherapy) had greater rates of margin negative (80.2% vs 73.0%, P < .001) and node negative (58.2% vs 28.7%, P < .001) resections and shorter mean durations of stay (12.0 vs 11.1 days, P = .012) than those receiving either adjuvant chemotherapy or no chemotherapy at all. There were no differences in 30-day unplanned readmissions (P = .074) and 90-day mortality (P = .227). On Cox survival analysis, adjusted for clinical variables including age and comorbid disease, patients undergoing perioperative chemotherapy, adjuvant chemotherapy, and neoadjuvant chemotherapy alone demonstrated significantly improved overall survival relative to that of patients undergoing resection alone (all P < .001). Patients receiving perioperative chemotherapy demonstrated a significant overall survival advantage compared with those receiving adjuvant chemotherapy (hazard ratio 0.75; 95% confidence interval, 0.65-0.85). Neoadjuvant chemotherapy alone had a marginal overall survival benefit compared with adjuvant chemotherapy (hazard ratio 0.89; 95% confidence interval, 0.81-0.98).
  
  
  
  Early stage pancreatic cancer patients who receive perioperative chemotherapy have better overall survival than those receiving no chemotherapy, adjuvant chemotherapy, or neoadjuvant chemotherapy alone. Patterns of postoperative morbidity are similar regardless of the sequence of therapy. Neoadjuvant chemotherapy should be considered for patients presenting with early stage pancreatic cancer.
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Waseem
authors.initials: W
authors.lastname: Lutfi
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.affiliation: Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Olga
authors.initials: O
authors.lastname: Kantor
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Chi-Hsiung
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Erik
authors.initials: E
authors.lastname: Liederbach
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Stocker
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.affiliation: Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Roggin
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Robert
authors.initials: R
authors.lastname: Marsh
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prinz
authors.affiliation: Department of Surgery, North Shore University Health System, Evanston, IL. Electronic address: mbaker3@northshore.org.
authors.forename: Marshall S
authors.initials: MS
authors.lastname: Baker
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D019990:Perioperative Care; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents