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Effect of Neoadjuvant Chemoradiation on Operative Mortality and Morbidity for Pancreaticoduodenectomy

Department of Surgery, Duke University Medical Center, Box 3118, Durham, North Carolina 27710

Correspondence: Address correspondence and reprint requests to: Douglas S. Tyler, MD; E-mail: tyler002{at}acpub.duke.edu

Background: Neoadjuvant chemoradiotherapy (neo-CRT) is being used with increasing frequency for periampullary tumors, but how it alters the complication rate of pancreaticoduodenectomy (PD) is unclear.

Methods: A retrospective analysis was conducted of 79 patients with periampullary malignancies who received 5-fluorouracil–based neo-CRT followed by PD.

Results: There was no difference in mortality between PD after neo-CRT (3.8%) and conventional PD for either malignant (4.5%) or benign (2.2%) disease. Focusing only on patients with malignancy, the neo-CRT group had a significantly lower pancreatic leak rate than the conventional group (10% vs. 43%; P < .001). Intra-abdominal abscesses were less common in the neo-CRT group (8.8% vs. 21%; P = .019), and there was one (1.2%) amylase-rich abscess in neo-CRT group, compared with eight (12%) in the conventional group. In addition, two patients in the conventional group died of leak-associated sepsis, compared with none in the neo-CRT group. Multivariate analysis revealed that neoadjuvant chemoradiation (odds ratio, .15) was the most significant factor associated with a reduced risk of pancreatic leak.

Conclusions: Neo-CRT does not increase the mortality or morbidity of PD. In contrast, neo-CRT was associated with a marked reduction in the incidence of pancreatic leak, as well as leak-associated morbidity and mortality.

Key Words: Pancreaticoduodenectomy • Neoadjuvant therapy • Morbidity • Mortality • Pancreatic leak

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