Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy
© 2023. Society of Surgical Oncology..
BACKGROUND: Several international high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC) following chemo(radio)therapy, but it is unclear how this translates to nationwide clinical practice and outcome. This study aims to assess the nationwide use and outcome of resection of LAPC following induction chemo(radio)therapy.
PATIENTS AND METHODS: A multicenter retrospective study including all patients who underwent resection for LAPC following chemo(radio)therapy in all 16 Dutch pancreatic surgery centers (2014-2020), registered in the mandatory Dutch Pancreatic Cancer Audit. LAPC is defined as arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion.
RESULTS: Overall, 142 patients underwent resection for LAPC, of whom 34.5% met the 2022 National Comprehensive Cancer Network criteria. FOLFIRINOX was the most commonly (93.7%) used chemotherapy [median 5 cycles (IQR 4-8)]. Venous and arterial resections were performed in 51.4% and 14.8% of patients. Most resections (73.9%) were performed in high-volume centers (i.e., ≥ 60 pancreatoduodenectomies/year). Overall median volume of LAPC resections/center was 4 (IQR 1-7). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median OS from diagnosis was 26 months (95% CI 23-28) and 5-year OS 18%. Surgery in high-volume centers [HR = 0.542 (95% CI 0.318-0.923)], ypN1-2 [HR = 3.141 (95% CI 1.886-5.234)], and major morbidity [HR = 2.031 (95% CI 1.272-3.244)] were associated with OS.
CONCLUSIONS: Resection of LAPC following chemo(radio)therapy is infrequently performed in the Netherlands, albeit with acceptable morbidity, mortality, and OS. Given these findings, a structured nationwide approach involving international centers of excellence would be needed to improve selection of patients with LAPC for surgical resection following induction therapy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Annals of surgical oncology - 31(2024), 4 vom: 25. März, Seite 2640-2653 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Stoop, Thomas F [VerfasserIn] |
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| Links: |
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| Themen: |
Fluorouracil |
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| Anmerkungen: |
Date Completed 06.03.2024 Date Revised 06.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1245/s10434-023-14650-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. Society of Surgical Oncology. | ||
| 520 | |a BACKGROUND: Several international high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC) following chemo(radio)therapy, but it is unclear how this translates to nationwide clinical practice and outcome. This study aims to assess the nationwide use and outcome of resection of LAPC following induction chemo(radio)therapy | ||
| 520 | |a PATIENTS AND METHODS: A multicenter retrospective study including all patients who underwent resection for LAPC following chemo(radio)therapy in all 16 Dutch pancreatic surgery centers (2014-2020), registered in the mandatory Dutch Pancreatic Cancer Audit. LAPC is defined as arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion | ||
| 520 | |a RESULTS: Overall, 142 patients underwent resection for LAPC, of whom 34.5% met the 2022 National Comprehensive Cancer Network criteria. FOLFIRINOX was the most commonly (93.7%) used chemotherapy [median 5 cycles (IQR 4-8)]. Venous and arterial resections were performed in 51.4% and 14.8% of patients. Most resections (73.9%) were performed in high-volume centers (i.e., ≥ 60 pancreatoduodenectomies/year). Overall median volume of LAPC resections/center was 4 (IQR 1-7). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median OS from diagnosis was 26 months (95% CI 23-28) and 5-year OS 18%. Surgery in high-volume centers [HR = 0.542 (95% CI 0.318-0.923)], ypN1-2 [HR = 3.141 (95% CI 1.886-5.234)], and major morbidity [HR = 2.031 (95% CI 1.272-3.244)] were associated with OS | ||
| 520 | |a CONCLUSIONS: Resection of LAPC following chemo(radio)therapy is infrequently performed in the Netherlands, albeit with acceptable morbidity, mortality, and OS. Given these findings, a structured nationwide approach involving international centers of excellence would be needed to improve selection of patients with LAPC for surgical resection following induction therapy | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Induction therapy | |
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| 650 | 4 | |a Pancreatic cancer | |
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| 700 | 1 | |a Lutchman, Kishan R D |e verfasserin |4 aut | |
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| 700 | 1 | |a Lips, Daan J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Harst, Erwin |e verfasserin |4 aut | |
| 700 | 1 | |a Kazemier, Geert |e verfasserin |4 aut | |
| 700 | 1 | |a Patijn, Gijs A |e verfasserin |4 aut | |
| 700 | 1 | |a de Hingh, Ignace H |e verfasserin |4 aut | |
| 700 | 1 | |a Wijsman, Jan H |e verfasserin |4 aut | |
| 700 | 1 | |a Erdmann, Joris I |e verfasserin |4 aut | |
| 700 | 1 | |a Festen, Sebastiaan |e verfasserin |4 aut | |
| 700 | 1 | |a Groot Koerkamp, Bas |e verfasserin |4 aut | |
| 700 | 1 | |a Mieog, J Sven D |e verfasserin |4 aut | |
| 700 | 1 | |a den Dulk, Marcel |e verfasserin |4 aut | |
| 700 | 1 | |a Stommel, Martijn W J |e verfasserin |4 aut | |
| 700 | 1 | |a Busch, Olivier R |e verfasserin |4 aut | |
| 700 | 1 | |a de Wilde, Roeland F |e verfasserin |4 aut | |
| 700 | 1 | |a de Meijer, Vincent E |e verfasserin |4 aut | |
| 700 | 1 | |a Te Riele, Wouter |e verfasserin |4 aut | |
| 700 | 1 | |a Molenaar, I Quintus |e verfasserin |4 aut | |
| 700 | 1 | |a van Eijck, Casper H J |e verfasserin |4 aut | |
| 700 | 1 | |a van Santvoort, Hjalmar C |e verfasserin |4 aut | |
| 700 | 1 | |a Besselink, Marc G |e verfasserin |4 aut | |
| 700 | 0 | |a Dutch Pancreatic Cancer Group |e verfasserin |4 aut | |
| 700 | 1 | |a Vlijm, Anniek |e investigator |4 oth | |
| 700 | 1 | |a Bonsing, Bert A |e investigator |4 oth | |
| 700 | 1 | |a Nio, C Yung |e investigator |4 oth | |
| 700 | 1 | |a de Groot, Derik-Jan |e investigator |4 oth | |
| 700 | 1 | |a Gootjes, Elske |e investigator |4 oth | |
| 700 | 1 | |a van Veldhuisen, Eran |e investigator |4 oth | |
| 700 | 1 | |a Manusama, Eric |e investigator |4 oth | |
| 700 | 1 | |a Wit, Fenny |e investigator |4 oth | |
| 700 | 1 | |a Daams, Freek |e investigator |4 oth | |
| 700 | 1 | |a Cirkel, Geert |e investigator |4 oth | |
| 700 | 1 | |a van Tienhoven, Geertjan |e investigator |4 oth | |
| 700 | 1 | |a van Hellemond, Irene |e investigator |4 oth | |
| 700 | 1 | |a Wilmink, Johanna W |e investigator |4 oth | |
| 700 | 1 | |a de Vos-Geelen, Judith |e investigator |4 oth | |
| 700 | 1 | |a Bosscha, Koop |e investigator |4 oth | |
| 700 | 1 | |a Mekenkamp, Leonie J |e investigator |4 oth | |
| 700 | 1 | |a Nijkamp, Maarten W |e investigator |4 oth | |
| 700 | 1 | |a Los, Maartje |e investigator |4 oth | |
| 700 | 1 | |a van der Kolk, Marion B |e investigator |4 oth | |
| 700 | 1 | |a Homs, Marjolein |e investigator |4 oth | |
| 700 | 1 | |a Ramaekers, Mark |e investigator |4 oth | |
| 700 | 1 | |a Liem, Mike S |e investigator |4 oth | |
| 700 | 1 | |a Wumkes, Miriam |e investigator |4 oth | |
| 700 | 1 | |a Michiels, Nynke |e investigator |4 oth | |
| 700 | 1 | |a van Dam, Ronald |e investigator |4 oth | |
| 700 | 1 | |a Theijse, Rutger T |e investigator |4 oth | |
| 700 | 1 | |a Luelmo, Saskia |e investigator |4 oth | |
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| 700 | 1 | |a Draaisma, Werner |e investigator |4 oth | |
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