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Multicenter Study
. 2021 Nov 1;274(5):721-728.
doi: 10.1097/SLA.0000000000005132.

The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis

Nikolaos Machairas  1 , Dimitri A Raptis  1   2 , Patricia Sánchez Velázquez  3 , Alain Sauvanet  4 , Alexandra Rueda de Leon  5 , Atsushi Oba  6 , Bas Groot Koerkamp  7 , Brendan Lovasik  8 , Carlos Chan  5 , Charles J Yeo  9 , Claudio Bassi  10 , Cristina R Ferrone  11 , David Kooby  8 , David Moskal  9 , Domenico Tamburrino  12 , Dong-Sup Yoon  13 , Eduardo Barroso  14 , Eduardo de Santibañes  15 , Emanuele F Kauffmann  16 , Emanuel Vigia  14 , Fabien Robin  17 , Fabio Casciani  10 , Fernando Burdío  3 , Giulio Belfiori  12 , Giuseppe Malleo  10 , Harish Lavu  9 , Hermien Hartog  7 , Ho-Kyoung Hwang  13 , Ho-Seong Han  18 , Hugo P Marques  14 , Ignasi Poves  3 , Ismael Domínguez-Rosado  5 , Joon-Seong Park  13 , Keith D Lillemoe  11 , Keith Roberts  19 , Laurent Sulpice  17 , Marc G Besselink  20 , Mahmoud Abuawwad  21 , Marco Del Chiaro  6 , Martin de Santibañes  15 , Massimo Falconi  12 , Mizelle D'Silva  18 , Michael Silva  22 , Mohammed Abu Hilal  21   23 , Motaz Qadan  11 , Naomi M Sell  11 , Nassiba Beghdadi  4 , Niccolò Napoli  16 , Olivier R C Busch  20 , Oscar Mazza  15 , Paolo Muiesan  19 , Philip C Müller  24 , Reena Ravikumar  22 , Richard Schulick  6 , Sarah Powell-Brett  19 , Syed Hussain Abbas  22 , Tara M Mackay  20 , Thomas F Stoop  20 , Tom K Gallagher  25 , Ugo Boggi  16 , Casper van Eijck  7 , Pierre-Alain Clavien  24 , Kevin C P Conlon  25 , Giuseppe Kito Fusai  1   2
Affiliations
Multicenter Study

The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis

Nikolaos Machairas et al. Ann Surg. .

Abstract

Objective: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers.

Summary of background data: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients.

Methods: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018.

Results: Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P <0.001). Multivariable analysis showed no administration of NAT, high tumor grade, lymphovascular invasion, R1/R2 resection, no adjuvant chemotherapy, occurrence of Clavien-Dindo grade 3 or higher postoperative complications within 90 days, preoperative diabetes mellitus, male sex and portal vein involvement were negative independent predictive factors for OS.

Conclusion: Patients with PDAC of the pancreatic head expected to undergo venous reconstruction should routinely be considered for NAT.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

References

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