Outcomes of Adjuvant Chemoradiation After Pancreaticoduodenectomy With Mesenterico-Portal Vein Resection for Adenocarcinoma of the Pancreas
- Department of Radiation Oncology and Molecular Radiation Sciences, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD (United States)
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD (United States)
- Department of Surgery, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD (United States)
- Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, MD (United States)
Purpose: Surgery followed by chemotherapy and radiation (CRT) offers patients with pancreatic adenocarcinoma a chance for extended survival. In some patients, however, resection is difficult because of vascular involvement by the carcinoma, necessitating resection and grafting of the mesenterico-portal vessels. The purpose of this study was to compare outcomes between pancreaticoduodenectomy (PD) with and without mesenterico-portal vein resection (VR) in patients receiving adjuvant CRT for pancreatic adenocarcinoma. Methods and Materials: Between 1993 and 2005, 160 patients underwent PD with 5-FU-based adjuvant CRT followed by maintenance chemotherapy at the Johns Hopkins Hospital; 20 (12.5%) of the 160 underwent VR. Clinical outcomes, including median survival, overall survival, and complication rates were assessed for both groups. Results: Patients who underwent VR had significantly longer operative times (p = 0.009), greater intraoperative blood loss (p = 0.01), and longer postoperative lengths of stay (p = 0.03). However, postoperative morbidity, median survival, and overall survival rates were similar between the two groups. Most patients (70%) from both groups were able to complete CRT, and a subgroup analysis demonstrated no appreciable differences in terms of complications. None of the VR patients who received adjuvant CRT developed veno-occlusive disease or graft failure/leakage. Conclusion: In a cohort of patients treated with adjuvant 5-FU-based CRT at the Johns Hopkins Hospital, having a VR at the time of PD resulted in similar complication rates and survival. These data support the feasibility and safety of adjuvant CRT in patients undergoing VR at the time of PD.
- OSTI ID:
- 21367602
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 76, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2009.01.047; PII: S0360-3016(09)00188-6; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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