Early initiation of adjuvant chemotherapy improves survival of patients with pancreatic carcinoma after surgical resection
Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan, . Cancer Chemotherapy and Pharmacology
(Impact Factor: 2.77).
11/2012; 71(2). DOI: 10.1007/s00280-012-2029-1
Adjuvant chemotherapy is accepted as a standard treatment after surgical resection of pancreatic carcinoma; however, the optimal timing between surgery and initiation of adjuvant chemotherapy has not been reported. The aim of this study was to determine the optimal timing of adjuvant chemotherapy after surgical resection of pancreatic carcinoma.
Records of 104 patients who received adjuvant chemotherapy after curative surgical resection of pancreatic carcinoma were reviewed retrospectively. Patients were grouped according to whether they received initial adjuvant chemotherapy within 20 days after surgery (</= 20 days, n = 57) or more than 20 days after surgery (>20 days, n = 47). Relationships between time to initiation of adjuvant chemotherapy, other clinicopathological factors, and survival were analyzed.
The rate of postoperative complication was significantly lower than in the </= 20 days group compared with the >20 days group (P = 0.003); no significant difference in other clinicopathological factors was found. Multivariate analysis revealed that time to initiation of adjuvant chemotherapy was an independent prognostic factor of disease-free survival (P = 0.009) and overall survival (P = 0.037). The </= 20 days group had longer 5-year overall survival rates than did the >20 days group (52 vs. 26 %, P = 0.013) as well as longer 5-year disease-free survival rates (53 vs. 22 %, P = 0.007).
Adjuvant chemotherapy for patients with resected pancreatic carcinoma should be initiated as soon as possible after surgical resection. Prevention of postoperative complication is needed to enable early initiation.
Available from: Dale Vimalachandran
- "Recent meta-analyses have shown the benefit of early administration of chemotherapy, demonstrating a decrease in survival of 14% with every 4-week increase in delay to chemotherapy following resection [11, 12]. The finding of improved outcome with timely administration of adjuvant chemotherapy has also been documented in patients with cancer at other sites, most notably the breast [25–27] and pancreas . "
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Timely administration of adjuvant chemotherapy following colorectal resection is associated with improved outcome. We aim to assess the factors which are associated with delay to adjuvant chemotherapy in patients who underwent colorectal resection as part of an enhanced recovery protocol.
A univariate and multivariate analysis of patient data collected as part of a prospectively maintained database of colorectal cancer patients between 2007 and 2012.
166 patients underwent colorectal resection followed by adjuvant chemotherapy. Median postoperative hospital stay was 6 days, and time to commencement of adjuvant chemotherapy was 50 days. Longer inpatient stay correlated with increased time to adjuvant chemotherapy (P = 0.05). Factors found to be independently associated with duration of hospital stay and time to commencement of adjuvant chemotherapy included stoma formation (P = 0.032), anastaomotic leak (P = 0.027), and preoperative albumin (P = 0.027). The use of laparoscopic surgery was associated with shorter time to adjuvant chemotherapy but did not reach significance (P = 0.143).
A number of independent variables associated with delay to adjuvant therapy previously not described have been identified. Further work may be required to elucidate the effect that these variables have on long-term outcome.
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The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy (PD) for adenocarcinoma is still unclear.
A retrospective review of all patients undergoing PD at our institution between 1995 and 2011 was performed. Clinicopathological data, including Clavien–Dindo complication grade, time to adjuvant therapy (TTA), and survival, were analyzed.
A total of 1,144 patients underwent PD for adenocarcinoma between 1995 and 2011. The overall complication rate was 49.1 % and clinically severe complications (≥IIIb) occurred in 4.2 %. Overall, 621 patients (54.3 %) were known to have received adjuvant therapy. The median TTA was 60 days. Although the presence of a complication was associated with a delay in TTA (p = 0.002), the grade of complication was not (p = 0.112). On multivariate analysis, only age > 68 years (p 9 days (p = 0.002) correlated with no adjuvant therapy. Patients with postoperative complications were more likely to receive single adjuvant chemotherapy or radiation therapy (31.4 %) than were patients without complications (17.1 %; p
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ABSTRACT: Laparoscopic distal pancreatectomy for pancreatic cancer is being applied increasingly in selected cases. Open radical antegrade modular pancreatosplenectomy (RAMPS) was introduced to obtain a higher rate of tumor-free margins and a higher lymph node (LN) count. However, there is no standard laparoscopic technique for pancreatic cancer. We treated three patients with RAMPS using a ligament of Treitz approach. We started each procedure by dissecting the ligament of Treitz. We entered and spread the anterior space of the aorta and inferior vena cava. We then dissected the LN of the root of the supra-mesenteric artery and performed RAMPS. The mean number LN retrieved from the patients was 43 ± 22. All three patients underwent pancreatectomy to obtain tumor-free margins, and two patients began adjuvant chemotherapy by postoperative day 14. The ligament of Treitz approach in laparoscopic modified RAMPS offered tumor-free margins and the resection of sufficient regional LN. The procedure also allowed adjuvant chemotherapy to be started early.
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