Skip to main content
Home
Zeitschriften
Zeitungen
Podcast
Gesundheitspolitik
Praxis
Allerlei
Jobs
Fachgebiete
Allgemeinmedizin Anästhesiologie & Intensivmedizin Apotheke Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kinder & Jugendheilkunde Neurologie & Psychiatrie Orthopädie & Unfallchirurgie Pflege Urologie Zahnmedizin
Subfächer Innere Medizin
Diabetologie Gastroenterologie Infektiologie Kardiologie Onkologie und Hämatologie Pneumologie Rheumatologie
Fortbildungen
Überblick Fortbildungen DFP-Literaturstudium-Artikel DFP-Webcast Fortbildungen DFP-Podcasts
Erweiterte Suche
Anmelden
nach oben
European Surgery
Erschienen in:

01.06.2013 | Original Article

Gemcitabine-based neoadjuvant chemotherapy for locally advanced pancreatic cancer does not affect mortality and morbidity after pancreatic resection

verfasst von: K. Sahora, MD, M. Schindl, MD, I. Kuehrer, MD, G. Werba, MD, F. Fitzal, MD, P. Goetzinger, MD, M. Gnant, MD

Erschienen in: European Surgery | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Summary

Background

Neoadjuvant strategies for locally advanced pancreatic cancer (PC) have been increasingly studied over the last decade. The effect of only systemic chemotherapy on postoperative morbidity and mortality remains unclear. The objective of this study was to determine the risk of postoperative complications in patients undergoing pancreatic resection for locally advanced, nonmetastatic PC following neoadjuvant gemcitabine-based chemotherapy.

Methods

Between 1994 and 2010, thirty-five patients who received gemcitabine-based neoadjuvant chemotherapy followed by pancreatic resection (Neo-gem group) were compared with 140 patients who had only pancreatic resection without neoadjuvant chemotherapy (Prim-surg group).

Results

Overall postoperative morbidity was similar in the Neo-gem and Prim-surg groups (57 vs. 51 %; P = 0.545). Major postoperative complications (Grade III–V) requiring radiological or surgical intervention occurred in 23 % of patients in the Neo-gem group and 26 % of patients in the Prim-surg group (P = 0.665). Within the Neo-gem group univariate and multivariate analysis identified the number of intraoperative blood transfusions as an independent risk factor for postoperative complications Grade I–V (P = 0.02), and vascular resection for major complications Grade III–V (P = 0.04).

Conclusions

Neoadjuvant gemcitabine-based chemotherapy is not associated with an increase in postoperative complications following pancreatic resection for locally advanced PC.
Vorheriger Artikel Tissue engineering in thoracic surgery
Nächster Artikel Fatal arterial complications following ultrasound-guided attempt of internal jugular vein catheterization
Literatur
1.
Sosa JA, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998;228:429–38.PubMedCrossRef
2.
van Heek NT, Kuhlmann KF, Scholten RJ, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242:781–8 (discussion 788–90).PubMedCrossRef
3.
Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55:10–30.PubMedCrossRef
4.
Cheng TY, Sheth K, White RR, et al. Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy. Ann Surg Oncol. 2006;13:66–74.PubMedCrossRef
5.
Turrini O, Moutardier V, Guiramand J, et al. Long-term morbidity of neoadjuvant chemoradiation for pancreatic head adenocarcinoma. Eur J Surg Oncol. 2006;32:77–9.PubMedCrossRef
6.
Heinrich S, Schafer M, Weber A, et al. Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity: results of a prospective phase ii trial. Ann Surg. 2008;248:1014–22.PubMedCrossRef
7.
Abbott DE, Baker MS, Talamonti MS. Neoadjuvant therapy for pancreatic cancer: a current review. J Surg Oncol. 2010;101:315–20.PubMedCrossRef
8.
Sahora K, Kuehrer I, Schindl M, et al. Neogemtax: gemcitabine and docetaxel as neoadjuvant treatment for locally advanced nonmetastasized pancreatic cancer. World J Surg. 2011;35:1580–9.
9.
Sahora K, Kuehrer I, Eisenhut A, et al. Neogemox: gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer. Surgery. 2011;149:311–20.PubMedCrossRef
10.
O’Connell RL, Lim LL. Utility of the Charlson comorbidity index computed from routinely collected hospital discharge diagnosis codes. Methods Inf Med. 2000;39:7–11.PubMed
11.
Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.PubMedCrossRef
12.
Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical ct. AJR Am J Roentgenol. 1997;168:1439–43.PubMedCrossRef
13.
Katz MHG, Pisters PWT, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–46 (discussion 846–8).PubMedCrossRef
14.
Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.PubMedCrossRef
15.
Longmire WP Jr., Tompkins RK, Traverso LW, et al. The surgical treatment of pancreatic disease. Jpn J Surg. 1978;8:249–60.PubMedCrossRef
16.
Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978;146:959–62.PubMed
17.
Watson WG. The surgical treatment of pancreatic and bile duct tumors. Pa Med J. 1950;53:700–2.PubMed
18.
Whipple AO. An evaluation of radical surgery for carcinoma of the pancreas and ampullary region. Ann Intern Med. 1949;31:624–7.PubMedCrossRef
19.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef
20.
DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–7 (discussion 937–9).PubMedCrossRef
21.
Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRef
22.
Reim D, Huser N, Humberg D, et al. Preoperative clinically inapparent leucopenia in patients undergoing neoadjuvant chemotherapy for locally advanced gastric cancer is not a risk factor for surgical or general postoperative complications. J Surg Oncol. 2010;102:321–4.PubMedCrossRef
23.
van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–37.CrossRef
24.
Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13:2163–9.PubMedCrossRef
25.
Jethwa P, Breuning E, Bhati C, et al. The microbiological impact of preoperative biliary drainage on patients undergoing hepato-biliary-pancreatic (HPB) surgery. Aliment Pharmacol Ther. 2007;25:1175–80.PubMedCrossRef
26.
McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246:246–53.PubMedCrossRef
27.
Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients. Surgery. 2006;139:591–8.PubMedCrossRef
28.
Kleeff J, Diener MK, Z’Graggen K, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.PubMedCrossRef
29.
Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232:786–95.PubMedCrossRef
30.
Mezhir JJ. Management of complications following pancreatic resection: an evidence-based approach. J Surg Oncol. 2013;107(1):58–66.PubMedCrossRef
31.
Palmer DH, Stocken DD, Hewitt H, et al. A randomized phase 2 trial of neoadjuvant chemotherapy in resectable pancreatic cancer: gemcitabine alone versus gemcitabine combined with cisplatin. Ann Surg Oncol. 2007;14:2088–96.PubMedCrossRef
32.
Allendorf JD, Lauerman M, Bill A, et al. Neoadjuvant chemotherapy and radiation for patients with locally unresectable pancreatic adenocarcinoma: feasibility, efficacy, and survival. J Gastrointest Surg. 2008;12:91–100.PubMedCrossRef
33.
Golcher H, Brunner T, Grabenbauer G, et al. Preoperative chemoradiation in adenocarcinoma of the pancreas. a single centre experience advocating a new treatment strategy. Eur J Surg Oncol. 2008;34:756–64.PubMedCrossRef
34.
Kastl S, Brunner T, Herrmann O, et al. Neoadjuvant radio-chemotherapy in advanced primarily nonresectable carcinomas of the pancreas. Eur J Surg Oncol. 2000;26:578–82.PubMedCrossRef
35.
Massucco P, Capussotti L, Magnino A, et al. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: analysis of perioperative outcome and survival. Ann Surg Oncol. 2006;13:1201–8.PubMedCrossRef
36.
Sa Cunha A, Rault A, Laurent C, et al. Surgical resection after radiochemotherapy in patients with unresectable adenocarcinoma of the pancreas. J Am Coll Surg. 2005;201:359–65.PubMedCrossRef
37.
Snady H, Bruckner H, Cooperman A, et al. Survival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma. An outcomes trial. Cancer. 2000;89:314–27.PubMedCrossRef
38.
Wanebo HJ, Glicksman AS, Vezeridis MP, et al. Preoperative chemotherapy, radiotherapy, and surgical resection of locally advanced pancreatic cancer. Arch Surg. 2000;135:81–7 (discussion 88).PubMedCrossRef
39.
Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.PubMedCrossRef
40.
Chua TC, Saxena A. Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg. 2010;14:1442–52.PubMedCrossRef
41.
Yekebas EF, Bogoevski D, Cataldegirmen G, et al. En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg. 2008;247:300–9.PubMedCrossRef
42.
Chakravarty KD, Hsu JT, Liu KH, et al. Prognosis and feasibility of en bloc vascular resection in stage II pancreatic adenocarcinoma. World J Gastroenterol. 2010;16:997–1002.PubMedCrossRef
43.
Robinson K, Lambiase L, Li J, et al. Fatal cholestatic liver failure associated with gemcitabine therapy. Dig Dis Sci. 2003;48:1804–8.PubMedCrossRef
44.
Coeman DC, Verbeken EK, Nackaerts KL, et al. A fatal case of cholestatic liver failure probably related to gemcitabine. Ann Oncol. 2000;11:1503.PubMedCrossRef
Metadaten
Titel
Gemcitabine-based neoadjuvant chemotherapy for locally advanced pancreatic cancer does not affect mortality and morbidity after pancreatic resection
verfasst von
K. Sahora, MD
M. Schindl, MD
I. Kuehrer, MD
G. Werba, MD
F. Fitzal, MD
P. Goetzinger, MD
M. Gnant, MD
Publikationsdatum
01.06.2013
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 3/2013
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-013-0213-0

Weitere Artikel der Ausgabe 3/2013

Concentrated sugar belongs to the museum

  • Editorial

Erratum to: Effects of everolimus on hepatic ischemia/reperfusion injury in an experimental rat model

  • Erratum

Tissue engineering in thoracic surgery

  • Main Topic

Fatal arterial complications following ultrasound-guided attempt of internal jugular vein catheterization

  • Case Report

Articular cartilage tissue regeneration—current research strategies and outlook for the future

  • Main Topic

Tissue engineering and its potential use in surgery

  • Editorial