Pancreatectomy with Vascular Resection After Neoadjuvant FOLFIRINOX: Who Survives More Than a Year After Surgery?
Résumé
Background: Experienced pancreatic surgeons, for whom complexity is not an issue, must decide at the end of neoadjuvant therapy whether to continue or discontinue surgery, when pancreatectomy with vascular resection is planned in patients with pancreatic ductal adenocarcinoma (PDAC). Objective: Our study aimed to determine preoperative factors that can predict short postoperative survival in such situations. Methods: Overall, 105 patients with borderline or locally advanced PDAC received neoadjuvant FOLFIRINOX (followed by chemoradiation in 22% of patients) and underwent pancreatectomy with segmental venous and/or arterial resection at two high-volume centers. The primary endpoint was overall survival (OS) of < 1 year after surgery for patients who did not die from the surgery. Results: Tumors were classified as borderline in 78% of cases and locally advanced in 22% of cases. Mean CA19-9 at diagnosis was 934 U/mL, which significantly decreased to 213 U/mL (p < 0.01) after a median of six cycles of FOLFIRINOX. Pancreaticoduodenectomy was performed most often (76%). The vast majority of patients underwent venous resection (92%), and a simultaneous arterial resection was performed in 16 patients (15%). The severe morbidity rate and 30- and 90-day mortality rates were 21%, 8.5%, and 10.4%, respectively. The median OS after surgery was 23 months. In the multivariate analysis, preoperative CA19-9 ≥ 450 U/mL was the only preoperative factor independently associated with OS of < 1 year (p = 0.044). Conclusion: The preoperative CA19-9 value should be considered in the clinical decision-making process when complex vascular resection is required. © 2021, Society of Surgical Oncology.
Mots clés
antineoplastic agent
CA 19-9 antigen
capecitabine
fluorouracil
folinic acid
granulocyte colony stimulating factor
heparin
irinotecan
low molecular weight heparin
oxaliplatin
folfirinox
adjuvant chemotherapy
adjuvant therapy
adult
aged
anticoagulant therapy
Article
backache
body weight loss
cancer combination chemotherapy
cancer mortality
cancer surgery
cancer survival
cause of death
chemoradiotherapy
collateral circulation
continuous infusion
controlled study
failure to thrive
female
follow up
gastric artery
heart infarction
heparinization
hepatic artery
hospital readmission
hospitalization
human
intensity modulated radiation therapy
length of stay
lung embolism
lymph node ratio
major clinical study
male
morbidity
mortality rate
multiple cycle treatment
multiple organ failure
neoadjuvant chemotherapy
neutropenia
overall survival
pancreas adenocarcinoma
pancreas fistula
pancreatectomy
pancreaticoduodenectomy
perineural invasion
peritonitis
postoperative hemorrhage
postoperative inflammation
postoperative period
predictive value
proper hepatic artery
reoperation
retrospective study
tumor invasion
vascular surgery
neoadjuvant therapy
pancreas carcinoma
pancreas tumor
Antineoplastic Combined Chemotherapy Protocols
Carcinoma
Pancreatic Ductal
Fluorouracil
Humans
Irinotecan
Leucovorin
Neoadjuvant Therapy
Oxaliplatin
Pancreatectomy
Pancreatic Neoplasms
Retrospective Studies