Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy? J Am Coll Surg 2007 Mar;204(3):347-55
Date
02/28/2007Pubmed ID
17324767DOI
10.1016/j.jamcollsurg.2006.12.011Scopus ID
2-s2.0-33847117592 (requires institutional sign-in at Scopus site) 112 CitationsAbstract
BACKGROUND: Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as initial treatment for pancreatic adenocarcinoma. This study reexamined the frequency of delayed recovery and assessed other factors associated with adjuvant therapy administration after PD at a high-volume center.
STUDY DESIGN: Preoperative and perioperative variables were reviewed in a consecutive series of 85 patients with pancreatic adenocarcinoma undergoing PD without preoperative chemotherapy or radiotherapy from 1990 to 2004.
RESULTS: Study groups included patients undergoing emergency PD (group 1, n=13); elective PD with good preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) (group 2, ECOG PS: 0 to 1, n=63); and elective PD with marginal preoperative PS (group 3, ECOG PS: 2 to 3, n=9). Delayed recovery of PS precluded adjuvant therapy in 23% of patients in group 1, 6% of patients in group 2, and 44% of patients in group 3 (p=0.0001).
CONCLUSIONS: The impact of delayed recovery after PD on the delivery of adjuvant therapy depends on the urgency of surgery and the preoperative PS. For patients with good preoperative PS who undergo elective PD at a high-volume center, it is uncommon for delayed recovery to preclude delivery of adjuvant therapy.
Author List
Aloia TA, Lee JE, Vauthey JN, Abdalla EK, Wolff RA, Varadhachary GR, Abbruzzese JL, Crane CH, Evans DB, Pisters PWAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenocarcinomaAdolescent
Adult
Aged
Antineoplastic Agents
Chemotherapy, Adjuvant
Elective Surgical Procedures
Female
Follow-Up Studies
Humans
Length of Stay
Male
Middle Aged
Pancreatic Neoplasms
Pancreaticoduodenectomy
Prospective Studies
Radiotherapy, Adjuvant
Risk Factors
Time Factors
Treatment Outcome