Preoperative Chemoradiation and Pancreaticoduodenectomy for Adenocarcinoma of the Pancreas

TLDR

Preoperative chemoradiation before pancreaticoduodenectomy ensures complete multimodality therapy, avoids surgery in rapidly progressive disease, and delivers radiation to well‑oxygenated tumor cells. Twenty‑eight patients with localized pancreatic head adenocarcinoma received fluorouracil and 50.4 Gy preoperative chemoradiation, all completing therapy, followed by restaging 4–5 weeks later to select patients for surgery. Nine patients required hospitalization for gastrointestinal toxicity but none had delayed surgery; of 23 who underwent laparotomy, 17 received pancreaticoduodenectomy, 3 had unsuspected metastases, 3 had unresectable disease, with one perioperative death, three complications, and tumor cell injury in all specimens, demonstrating a low complication incidence.

Abstract

Chemoradiation prior to pancreaticoduodenectomy ensures that all patients who undergo resection complete multimodality therapy, avoids resection in patients with rapidly progressive disease, and allows radiation therapy to be delivered to well-oxygenated cells before surgical devascularization. Twenty-eight patients with cytologic or histologic proof of localized adenocarcinoma of the pancreatic head received preoperative chemoradiation (fluorouracil, 300 mg/m2 per day, and 50.4 Gy) with the intent of proceeding to resection; all 28 completed this preoperative therapy. Hospital admission because of gastrointestinal toxic effects was required in nine patients, yet no patient experienced a delay in operation. Restaging was performed 4 to 5 weeks after completion of chemoradiation, and five patients were found to have metastatic disease; the 23 patients without evidence of progressive disease underwent laparotomy. At laparotomy, three patients were found to have unsuspected metastatic disease, three patients had unresectable locally advanced disease, and 17 patients were able to undergo pancreaticoduodenectomy. One perioperative death resulted from myocardial infarction, and perioperative complications occurred in three patients. Histologic evidence of tumor cell injury was present in all resected specimens. Our results suggest that pancreaticoduodenectomy can be performed with a low incidence of complications after chemoradiation for localized adenocarcinoma of the pancreas.