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Papavasiliou P , Hoffman JP , Cohen SJ , Meyer JE , Watson JC , Chun YS
Impact of preoperative therapy on patterns of recurrence in pancreatic cancer
HPB (Oxford). 2014 Jan;16(1) :34-9
PMID: 23458131    PMCID: PMC3892312    URL: https://www.ncbi.nlm.nih.gov/pubmed/23458131
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BACKGROUND: A theoretical advantage of preoperative therapy in pancreatic adenocarcinoma is that it facilitates the early treatment of micrometastases and reduces postoperative systemic recurrence. METHODS: Medical records of 309 consecutive patients undergoing resection of adenocarcinoma in the head of the pancreas were reviewed. Survival was calculated using the Kaplan-Meier method. Associations between preoperative therapy and patterns of recurrence were determined using chi-squared analysis. RESULTS: Preoperative therapy was administered to 108 patients and upfront surgery was performed in 201 patients. Preoperative therapy was associated with a significantly longer median disease-free survival of 14 months compared with 12 months in patients submitted to upfront surgery (P = 0.035). The rate of local disease as a component of first site of recurrence was significantly lower with preoperative therapy (11.3%) than with upfront surgery (22.9%) (P = 0.016). Preoperative therapy was associated with a lower rate of hepatic metastasis (21.7%) than upfront surgery (34.3%) (P = 0.026). Preoperative therapy did not affect rates of peritoneal or pulmonary metastasis. CONCLUSIONS: Preoperative therapy for pancreatic cancer was associated with longer disease-free survival and lower rates of local and hepatic recurrences. These data support the use of preoperative therapy to reduce systemic and local failures after resection.
Papavasiliou, Pavlos Hoffman, John P Cohen, Steven J Meyer, Joshua E Watson, James C Chun, Yun Shin eng England HPB (Oxford). 2014 Jan;16(1):34-9. doi: 10.1111/hpb.12058. Epub 2013 Feb 20.