Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study

R Theijse; T Stoop; M Katz; CWD Tzeng; AC Wei; AH Zureikat; BG Koerkamp; MG Besselink

doi:10.1016/S0016-5085(23)04511-0

Abstract

Background: Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy.

Methods: This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012-2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C).

Results: Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]).

Conclusion: More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes.

© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

Original language	English
Pages (from-to)	S1489-S1490
Number of pages	2
Journal	Gastroenterology
Volume	164
Issue number	6
DOIs	https://doi.org/10.1016/S0016-5085(23)04511-0
Publication status	Published - May 2023

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10.1016/S0016-5085(23)04511-0

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Theijse, R., Stoop, T., Katz, M., Tzeng, CWD., Wei, AC., Zureikat, AH., Koerkamp, BG., & Besselink, MG. (2023). Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study. Gastroenterology, 164(6), S1489-S1490. https://doi.org/10.1016/S0016-5085(23)04511-0

@article{cf9e59578986480a98a4c8530bae123e,

title = "Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study",

abstract = "Background: Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy. Methods: This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012-2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C). Results: Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1\%) in group A, 425 patients (64.1\%) in group B, and 171 patients (25.8\%) in group C). A non-therapeutic laparotomy occurred in 28.2\% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8\%) and a 90-day mortality rate of 3.0\% (2 of 67). Administration of palliative therapy (65.9\% versus 73.1\%; P = 0.307) and median overall survival (20.4 [95\% c.i. 15.9 to 27.3] versus 20.2 [95\% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95\% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4\%, 8.7\%, and 24.7\% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95\% c.i. 0.61 to 1.27]). Conclusion: More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes. {\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.",

author = "R Theijse and T Stoop and M Katz and CWD Tzeng and AC Wei and AH Zureikat and BG Koerkamp and MG Besselink",

year = "2023",

month = may,

doi = "10.1016/S0016-5085(23)04511-0",

language = "English",

volume = "164",

pages = "S1489--S1490",

journal = "Gastroenterology",

issn = "0016-5085",

number = "6",

}

Theijse, R, Stoop, T, Katz, M, Tzeng, CWD, Wei, AC, Zureikat, AH, Koerkamp, BG & Besselink, MG 2023, 'Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study', Gastroenterology, vol. 164, no. 6, pp. S1489-S1490. https://doi.org/10.1016/S0016-5085(23)04511-0

Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study. / Theijse, R; Stoop, T; Katz, M et al.
In: Gastroenterology, Vol. 164, No. 6, 05.2023, p. S1489-S1490.

Research output: Contribution to journal › Meeting Abstract › Academic › peer-review

TY - JOUR

T1 - Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study

AU - Theijse, R

AU - Stoop, T

AU - Katz, M

AU - Tzeng, CWD

AU - Wei, AC

AU - Zureikat, AH

AU - Koerkamp, BG

AU - Besselink, MG

PY - 2023/5

Y1 - 2023/5

N2 - Background: Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy. Methods: This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012-2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C). Results: Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]). Conclusion: More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes. © The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

AB - Background: Surgery in selected patients with locally advanced pancreatic cancer after induction chemotherapy may have drawbacks related to surgical risks and breaks or delays in oncological treatment, in particular when curative intent resection is not possible (that is non-therapeutic laparotomy). The aim of this study was to assess the incidence and oncological impact of a non-therapeutic laparotomy in patients with locally advanced pancreatic cancer treated with induction (m)FOLFIRINOX chemotherapy. Methods: This was a retrospective international multicentre study including patients diagnosed with pathology-proven locally advanced pancreatic cancer treated with at least one cycle of (m)FOLFIRINOX (2012-2019). Patients undergoing a non-therapeutic laparotomy (group A) were compared with those not undergoing surgery (group B) and those undergoing resection (group C). Results: Overall, 663 patients with locally advanced pancreatic cancer were included (67 patients (10.1%) in group A, 425 patients (64.1%) in group B, and 171 patients (25.8%) in group C). A non-therapeutic laparotomy occurred in 28.2% of all explorations (67 of 238), with occult metastases in 30 patients (30 of 67, 44.8%) and a 90-day mortality rate of 3.0% (2 of 67). Administration of palliative therapy (65.9% versus 73.1%; P = 0.307) and median overall survival (20.4 [95% c.i. 15.9 to 27.3] versus 20.2 [95% c.i. 19.1 to 22.7] months; P = 0.752) did not differ between group A and group B respectively. The median overall survival in group C was 36.1 (95% c.i. 30.5 to 41.2) months. The 5-year overall survival rates were 11.4%, 8.7%, and 24.7% in group A, group B, and group C, respectively. Compared with group B, non-therapeutic laparotomy (group A) was not associated with reduced overall survival (HR = 0.88 [95% c.i. 0.61 to 1.27]). Conclusion: More than a quarter of surgically explored patients with locally advanced pancreatic cancer after induction (m)FOLFIRINOX did not undergo a resection. Such non-therapeutic laparotomy does not appear to substantially impact oncological outcomes. © The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=eur_pure&SrcAuth=WosAPI&KeyUT=WOS:001040954706304&DestLinkType=FullRecord&DestApp=WOS_CPL

U2 - 10.1016/S0016-5085(23)04511-0

DO - 10.1016/S0016-5085(23)04511-0

M3 - Meeting Abstract

SN - 0016-5085

VL - 164

SP - S1489-S1490

JO - Gastroenterology

JF - Gastroenterology

IS - 6

ER -

Impact of a Non-therapeutic Laparotomy in Patients with Locally Advanced Pancreatic Cancer Undergoing Surgical Exploration Treated with Induction (m)folfirinox; a Taps Consortium Study

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