Delayed Recovery after Pancreaticoduodenectomy: A Major Factor Impairing the Delivery of Adjuvant Therapy?
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 ass...
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Published in | Journal of the American College of Surgeons Vol. 204; no. 3; pp. 347 - 355 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Elsevier Inc
01.03.2007
Elsevier Science |
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Abstract | 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. |
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AbstractList | 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.
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.
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).
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. 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. 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. 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). 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. BACKGROUNDDelayed 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 DESIGNPreoperative 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.RESULTSStudy 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).CONCLUSIONSThe 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. 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 | Evans, Douglas B., MD, FACS Wolff, Robert A., MD Pisters, Peter W.T., MD, FACS Lee, Jeffrey E., MD, FACS Vauthey, Jean-Nicolas, MD, FACS Crane, Christopher H., MD Varadhachary, Gauri R., MD Aloia, Thomas E., MD Abdalla, Eddie K., MD, FACS Abbruzzese, James L., MD, FACP |
Author_xml | – sequence: 1 fullname: Aloia, Thomas E., MD – sequence: 2 fullname: Lee, Jeffrey E., MD, FACS – sequence: 3 fullname: Vauthey, Jean-Nicolas, MD, FACS – sequence: 4 fullname: Abdalla, Eddie K., MD, FACS – sequence: 5 fullname: Wolff, Robert A., MD – sequence: 6 fullname: Varadhachary, Gauri R., MD – sequence: 7 fullname: Abbruzzese, James L., MD, FACP – sequence: 8 fullname: Crane, Christopher H., MD – sequence: 9 fullname: Evans, Douglas B., MD, FACS – sequence: 10 fullname: Pisters, Peter W.T., MD, FACS |
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Keywords | AT PS PD pancreaticoduodenectomy ECOG Eastern Cooperative Oncology Group adjuvant therapy performance status Medicine Duodenum Surgery Adjuvant treatment Delivery Pancreas Recovery Delay Pancreatoduodenectomy |
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Snippet | Background Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective... Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as... BACKGROUNDDelayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective... |
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SubjectTerms | Adenocarcinoma - drug therapy Adenocarcinoma - radiotherapy Adenocarcinoma - surgery Adolescent Adult Aged Antineoplastic Agents - therapeutic use Biological and medical sciences Chemotherapy, Adjuvant Elective Surgical Procedures - methods Female Follow-Up Studies General aspects Humans Length of Stay Male Medical sciences Middle Aged Pancreatic Neoplasms - drug therapy Pancreatic Neoplasms - radiotherapy Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Prospective Studies Radiotherapy, Adjuvant Risk Factors Stomach, duodenum, intestine, rectum, anus Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Time Factors Treatment Outcome |
Title | Delayed Recovery after Pancreaticoduodenectomy: A Major Factor Impairing the Delivery of Adjuvant Therapy? |
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