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The effect of preoperative chemotherapy and chemoradiotherapy on pancreatic fistula and other surgical complications after pancreatic resection: a systematic review and meta-analysis of comparative studies.
van Dongen, Jelle C; Wismans, Leonoor V; Suurmeijer, J Annelie; Besselink, Marc G; de Wilde, Roeland F; Groot Koerkamp, Bas; van Eijck, Casper H J.
Afiliação
  • van Dongen JC; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
  • Wismans LV; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
  • Suurmeijer JA; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
  • de Wilde RF; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
  • Groot Koerkamp B; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
  • van Eijck CHJ; Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. Electronic address: c.vaneijck@erasmusmc.nl.
HPB (Oxford) ; 23(9): 1321-1331, 2021 09.
Article em En | MEDLINE | ID: mdl-34099372
ABSTRACT

BACKGROUND:

Preoperative chemo- or chemoradiotherapy is recommended for borderline-resectable pancreatic cancer. The aim of this study was to determine the impact of preoperative therapy on surgical complications in patients with resected pancreatic cancer.

METHODS:

This systematic review and meta-analysis included studies reporting on the rate of surgical complications after preoperative chemo- or chemoradiotherapy versus immediate surgery in pancreatic cancer patients. The primary endpoint was the rate of grade B/C POPF. Pooled odds ratios were calculated using random-effects models.

RESULTS:

Forty-one comparative studies including 25,389 patients were included. Vascular resections were more often performed after preoperative therapy (29.4% vs. 15.7%, p < 0.001). Preoperative therapy was associated with a lower rate of grade B/C POPF as compared to immediate surgery (pooled OR 0.47, 95%CI 0.38-0.58). This reduction was mostly obtained by preoperative chemoradiotherapy (OR 0.46, 95%CI 0.29-0.73), but not by preoperative chemotherapy alone (OR 0.83, 95%CI 0.59-1.16). No difference was demonstrated for major morbidity, mortality, postpancreatectomy haemorrhage, delayed gastric emptying and overall morbidity.

CONCLUSION:

Preoperative chemo- and chemoradiotherapy in patients with pancreatic cancer appears to be safe with respect to POPF and other surgical complications as compared to immediate surgery. The reduced rate of POPF appears to be attributable to preoperative chemoradiation.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Fístula Pancreática Tipo de estudo: Diagnostic_studies / Etiology_studies / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Fístula Pancreática Tipo de estudo: Diagnostic_studies / Etiology_studies / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article