Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Impact of Neoadjuvant Therapy for Pancreatic Cancer : Transatlantic Trend and Postoperative Outcomes Analysis

Davis, Catherine H. ; Augustinus, Simone ; de Graaf, Nine ; Wellner, Ulrich F. ; Johansen, Karin ; Andersson, Bodil LU orcid ; Beane, Joal D. ; Björnsson, Bergthor ; Busch, Olivier R. and Gleeson, Elizabeth M. , et al. (2024) In Journal of the American College of Surgeons 238(4). p.613-621
Abstract

BACKGROUND: The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden. STUDY DESIGN: Databases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT... (More)

BACKGROUND: The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden. STUDY DESIGN: Databases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT was measured in each country over time. Thirty-day outcomes, including the composite measure (ideal outcomes), were compared by multivariable analyses. Sensitivity analyses of patients undergoing vascular resection were performed. RESULTS: Overall, 11,402 patients underwent PD for PDAC with 33.7% of patients receiving NAT. The use of NAT increased steadily from 28.3% in 2018 to 38.5% in 2020 (p < 0.0001). However, use of NAT varied widely by country: the US (46.8%), the Netherlands (44.9%), Sweden (11.0%), and Germany (7.8%). On multivariable analysis, NAT was significantly (p < 0.01) associated with reduced rates of serious morbidity, clinically relevant pancreatic fistulae, reoperations, and increased ideal outcomes. These associations remained on sensitivity analysis of patients undergoing vascular resection. CONCLUSIONS: NAT before PD for pancreatic cancer varied widely among 4 Western audits yet increased by 26% during 3 years. NAT was associated with improved short-term outcomes.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of the American College of Surgeons
volume
238
issue
4
pages
9 pages
publisher
Elsevier
external identifiers
  • pmid:38224148
  • scopus:85187812164
ISSN
1879-1190
DOI
10.1097/XCS.0000000000000971
language
English
LU publication?
yes
id
b9de9bcd-e639-45a9-a5b1-19798046c884
date added to LUP
2024-03-27 14:34:29
date last changed
2024-04-24 18:35:13
@article{b9de9bcd-e639-45a9-a5b1-19798046c884,
  abstract     = {{<p>BACKGROUND: The introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden. STUDY DESIGN: Databases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT was measured in each country over time. Thirty-day outcomes, including the composite measure (ideal outcomes), were compared by multivariable analyses. Sensitivity analyses of patients undergoing vascular resection were performed. RESULTS: Overall, 11,402 patients underwent PD for PDAC with 33.7% of patients receiving NAT. The use of NAT increased steadily from 28.3% in 2018 to 38.5% in 2020 (p &lt; 0.0001). However, use of NAT varied widely by country: the US (46.8%), the Netherlands (44.9%), Sweden (11.0%), and Germany (7.8%). On multivariable analysis, NAT was significantly (p &lt; 0.01) associated with reduced rates of serious morbidity, clinically relevant pancreatic fistulae, reoperations, and increased ideal outcomes. These associations remained on sensitivity analysis of patients undergoing vascular resection. CONCLUSIONS: NAT before PD for pancreatic cancer varied widely among 4 Western audits yet increased by 26% during 3 years. NAT was associated with improved short-term outcomes.</p>}},
  author       = {{Davis, Catherine H. and Augustinus, Simone and de Graaf, Nine and Wellner, Ulrich F. and Johansen, Karin and Andersson, Bodil and Beane, Joal D. and Björnsson, Bergthor and Busch, Olivier R. and Gleeson, Elizabeth M. and van Santvoort, Hjalmar C. and Tingstedt, Bobby and Williamsson, Caroline and Keck, Tobias and Besselink, Marc G. and Koerkamp, Bas Groot and Pitt, Henry A.}},
  issn         = {{1879-1190}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  pages        = {{613--621}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the American College of Surgeons}},
  title        = {{Impact of Neoadjuvant Therapy for Pancreatic Cancer : Transatlantic Trend and Postoperative Outcomes Analysis}},
  url          = {{http://dx.doi.org/10.1097/XCS.0000000000000971}},
  doi          = {{10.1097/XCS.0000000000000971}},
  volume       = {{238}},
  year         = {{2024}},
}