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  • Title: Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer.
    Author: Katz MH, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, Pisters PW, Lee JE, Vauthey JN, Abdalla EK, Wolff R, Abbruzzese J, Varadhachary G, Chopin-Laly X, Charnsangavej C, Fleming JB.
    Journal: J Gastrointest Surg; 2012 Jan; 16(1):68-78; discussion 78-9. PubMed ID: 22065318.
    Abstract:
    OBJECTIVES: To determine the influence of neoadjuvant chemoradiation and standardized dissection of the superior mesenteric artery upon the oncologic outcome of patients with localized pancreatic adenocarcinoma. METHODS: One hundred ninety-four patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy between 2004 and 2008 were evaluated. The retroperitoneal dissection was performed directly along the superior mesenteric artery in all cases. A standard histopathologic protocol that measured the "superior mesenteric artery (SMA) margin distance" between cancer cells and the superior mesenteric artery was employed. RESULTS: Seventy-six percent of patients received neoadjuvant chemoradiation. The SMA margin was positive in 4% of patients but an additional 22% of patients with a negative margin had a SMA margin distance of ≤1 mm. Preoperative CT images overestimated the SMA margin distance in 73% of cases. Patients who received chemoradiation had longer SMA margin distances than those who did not. Patients who received chemoradiation and had a SMA margin of >1 mm had the lowest recurrence rates. Administration of neoadjuvant chemoradiation and lower estimated blood loss were independently associated with longer progression-free survival on multivariate analysis. CONCLUSIONS: Preoperative chemoradiation and meticulous dissection of the superior mesenteric artery maximize the distance between cancer cells and the SMA margin and may influence locoregional control.
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