title: Preoperative Therapy and Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: a 25-Year Single-Institution Experience.
abstract: The purpose of this study was to evaluate a single-institution experience with delivery of preoperative therapy to patients with pancreatic ductal adenocarcinoma (PDAC) prior to pancreatoduodenectomy (PD).
  
  
  
  Consecutive patients (622) with PDAC who underwent PD following chemotherapy and/or chemoradiation between 1990 and 2014 were retrospectively reviewed. Preoperative treatment regimens, clinicopathologic characteristics, operative details, and long-term outcomes in four successive time periods (1990-1999, 2000-2004, 2005-2009, 2010-2014) were evaluated and compared.
  
  
  
  The average number of patients per year who underwent PD following preoperative therapy as well as the proportion of operations performed for borderline resectable and locally advanced (BR/LA) tumors increased over time. The use of induction systemic chemotherapy, as well as postoperative adjuvant chemotherapy, also increased over time. Throughout the study period, the mean EBL decreased while R0 margin rates and vascular resection rates increased overall. Despite the increase in BR/LA resections, locoregional recurrence (LR) rates remained similar over time, and overall survival (OS) improved significantly (median 24.1, 28.1, 37.3, 43.4 months, respectively, p < 0.0001).
  
  
  
  Despite increases in case complexity, relatively low rates of LR have been maintained while significant improvements in OS have been observed. Further improvements in patient outcomes will likely require disruptive advances in systemic therapy.
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Jordan M
authors: JM
authors: Cloyd
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Matthew H G
authors: MH
authors: Katz
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Laura
authors: L
authors: Prakash
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Gauri R
authors: GR
authors: Varadhachary
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Robert A
authors: RA
authors: Wolff
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Rachna T
authors: RT
authors: Shroff
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Milind
authors: M
authors: Javle
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: David
authors: D
authors: Fogelman
authors: Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Michael
authors: M
authors: Overman
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Christopher H
authors: CH
authors: Crane
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Eugene J
authors: EJ
authors: Koay
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Prajnan
authors: P
authors: Das
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Sunil
authors: S
authors: Krishnan
authors: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Bruce D
authors: BD
authors: Minsky
authors: Department of Gasteroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Jeffrey H
authors: JH
authors: Lee
authors: Department of Gasteroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Manoop S
authors: MS
authors: Bhutani
authors: Department of Gasteroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Brian
authors: B
authors: Weston
authors: Department of Gasteroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: William
authors: W
authors: Ross
authors: Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Priya
authors: P
authors: Bhosale
authors: Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Eric P
authors: EP
authors: Tamm
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Huamin
authors: H
authors: Wang
authors: Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: Anirban
authors: A
authors: Maitra
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Michael P
authors: MP
authors: Kim
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Thomas A
authors: TA
authors: Aloia
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Jean-Nicholas
authors: JN
authors: Vauthey
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA.
authors: Jason B
authors: JB
authors: Fleming
authors: Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA.
authors: James L
authors: JL
authors: Abbruzzese
authors: University Health Network, Toronto, ON, Canada.
authors: Peter W T
authors: PW
authors: Pisters
authors: Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Douglas B
authors: DB
authors: Evans
authors: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1484, Houston, TX, 77030, USA. jelee@mdanderson.org.
authors: Jeffrey E
authors: JE
authors: Lee
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D010190:Pancreatic Neoplasms; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care; D012189:Retrospective Studies
keywords: Neoadjuvant therapy; Pancreatectomy; Pancreatic ductal adenocarcinoma; Pancreatoduodenectomy