TY - JOUR
T1 - Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy
AU - Stoop, Thomas F.
AU - Seelen, Leonard W. F.
AU - van 't Land, Freek R.
AU - Lutchman, Kishan R. D.
AU - van Dieren, Susan
AU - Lips, Daan J.
AU - van der Harst, Erwin
AU - Kazemier, Geert
AU - Patijn, Gijs A.
AU - de Hingh, Ignace H.
AU - Wijsman, Jan H.
AU - Erdmann, Joris I.
AU - Festen, Sebastiaan
AU - Groot Koerkamp, Bas
AU - Mieog, J. Sven D.
AU - den Dulk, Marcel
AU - Stommel, Martijn W. J.
AU - Busch, Olivier R.
AU - de Wilde, Roeland F.
AU - de Meijer, Vincent E.
AU - te Riele, Wouter
AU - Molenaar, I. Quintus
AU - van Eijck, Casper H. J.
AU - van Santvoort, Hjalmar C.
AU - Besselink, Marc G.
AU - the Dutch Pancreatic Cancer Group (DPCG)
N1 - Publisher Copyright:
© Society of Surgical Oncology 2023.
PY - 2024/4
Y1 - 2024/4
N2 - Background: Several international high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC) following chemo(radio)therapy, but it is unclear how this translates to nationwide clinical practice and outcome. This study aims to assess the nationwide use and outcome of resection of LAPC following induction chemo(radio)therapy. Patients and Methods: A multicenter retrospective study including all patients who underwent resection for LAPC following chemo(radio)therapy in all 16 Dutch pancreatic surgery centers (2014–2020), registered in the mandatory Dutch Pancreatic Cancer Audit. LAPC is defined as arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion. Results: Overall, 142 patients underwent resection for LAPC, of whom 34.5% met the 2022 National Comprehensive Cancer Network criteria. FOLFIRINOX was the most commonly (93.7%) used chemotherapy [median 5 cycles (IQR 4–8)]. Venous and arterial resections were performed in 51.4% and 14.8% of patients. Most resections (73.9%) were performed in high-volume centers (i.e., ≥ 60 pancreatoduodenectomies/year). Overall median volume of LAPC resections/center was 4 (IQR 1–7). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median OS from diagnosis was 26 months (95% CI 23–28) and 5-year OS 18%. Surgery in high-volume centers [HR = 0.542 (95% CI 0.318–0.923)], ypN1-2 [HR = 3.141 (95% CI 1.886–5.234)], and major morbidity [HR = 2.031 (95% CI 1.272–3.244)] were associated with OS. Conclusions: Resection of LAPC following chemo(radio)therapy is infrequently performed in the Netherlands, albeit with acceptable morbidity, mortality, and OS. Given these findings, a structured nationwide approach involving international centers of excellence would be needed to improve selection of patients with LAPC for surgical resection following induction therapy.
AB - Background: Several international high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC) following chemo(radio)therapy, but it is unclear how this translates to nationwide clinical practice and outcome. This study aims to assess the nationwide use and outcome of resection of LAPC following induction chemo(radio)therapy. Patients and Methods: A multicenter retrospective study including all patients who underwent resection for LAPC following chemo(radio)therapy in all 16 Dutch pancreatic surgery centers (2014–2020), registered in the mandatory Dutch Pancreatic Cancer Audit. LAPC is defined as arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion. Results: Overall, 142 patients underwent resection for LAPC, of whom 34.5% met the 2022 National Comprehensive Cancer Network criteria. FOLFIRINOX was the most commonly (93.7%) used chemotherapy [median 5 cycles (IQR 4–8)]. Venous and arterial resections were performed in 51.4% and 14.8% of patients. Most resections (73.9%) were performed in high-volume centers (i.e., ≥ 60 pancreatoduodenectomies/year). Overall median volume of LAPC resections/center was 4 (IQR 1–7). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median OS from diagnosis was 26 months (95% CI 23–28) and 5-year OS 18%. Surgery in high-volume centers [HR = 0.542 (95% CI 0.318–0.923)], ypN1-2 [HR = 3.141 (95% CI 1.886–5.234)], and major morbidity [HR = 2.031 (95% CI 1.272–3.244)] were associated with OS. Conclusions: Resection of LAPC following chemo(radio)therapy is infrequently performed in the Netherlands, albeit with acceptable morbidity, mortality, and OS. Given these findings, a structured nationwide approach involving international centers of excellence would be needed to improve selection of patients with LAPC for surgical resection following induction therapy.
UR - http://www.scopus.com/inward/record.url?scp=85179662881&partnerID=8YFLogxK
U2 - 10.1245/s10434-023-14650-6
DO - 10.1245/s10434-023-14650-6
M3 - Article
C2 - 38105377
SN - 1068-9265
VL - 31
SP - 2640
EP - 2653
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 4
ER -