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J Surg Oncol. 2017 Aug;116(2):127-132. doi: 10.1002/jso.24630. Epub 2017 Apr 13.

Nationwide trends and outcomes associated with neoadjuvant therapy in pancreatic cancer: An analysis of 18 243 patients.

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Duke University Medical Center, Durham, North Carolina.



Neoadjuvant therapy has theoretical benefits for pancreatic cancer; however, its association with perioperative outcomes remains controversial. This study sought to evaluate variation in use of neoadjuvant therapy and outcomes following pancreatic resection.


The National Cancer Data Base (1998-2011) was queried for patients with Stage I or II pancreatic adenocarcinoma who underwent pancreaticoduodenectomy. Subjects were classified by use of neoadjuvant chemotherapy and/or radiation therapy. Factors associated with use of neoadjuvant therapy were evaluated, and outcomes were compared.


A 18 243 patients were identified; 1375 (7.5%) received neoadjuvant therapy. From 1998 to 2011, use of neoadjuvant therapy increased from 4.3% to 17.0%. Patients receiving neoadjuvant therapy were younger (63.1 vs 66.1 years, P = 0.001) and more likely to receive treatment at an academic facility (64.4% vs 51.4%, P < 0.001). Patients who received neoadjuvant therapy were more likely to have negative margins (77.8% vs 85.5%), negative lymph nodes (42.9% vs 59.3%) and tumors confined to the pancreas (65.8% vs 70.6%, all P < 0.001). Patients receiving neoadjuvant therapy had lower 30-day mortality (2.0% vs 4.6%, P < 0.001) and readmission rates (7.4% vs 9.5%, P = 0.02).


Neoadjuvant therapy use is increasing and associated with comparable short-term outcomes. Further studies are needed to identify patients who would benefit from neoadjuvant therapy.


neoadjuvant; outcomes; pancreatic cancer

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