An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma Journal Article

Authors: Stojadinovic, A.; Brooks, A.; Hoos, A.; Jaques, D. P.; Conlon, K. C.; Brennan, M. F.
Article Title: An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma
Abstract: BACKGROUND: Randomized prospective trials have addressed various treatment approaches to pancreatic adenocarcinoma in order to improve on the dismal prognosis associated with this disease. We conducted a comprehensive review of prospective randomized clinical trials and summarized the contemporary treatment of resectable pancreatic carcinoma. STUDY DESIGN: A literature search strategy identified prospective randomized clinical trials for pancreatic carcinoma using standard medical subject heading terms. The articles were critically reviewed and ranked according to a standardized three-tiered system (Ia, Ib, Ic) by a panel of experts. RESULTS: Surgical studies have demonstrated that morbidity and mortality are similar for pylorus-preserving and classic pancreaticoduodenectomy. Extended retroperitoneal lymphadenectomy can be performed with similar mortality but increased morbidity compared with standard pancreaticoduodenectomy but does not prolong survival. Pancreaticogastrostomy and pancreaticojejunostomy appear to be comparable techniques for pancreatic duct reconstruction. Pancreatic-enteric anastomosis is associated with lower rates of pancreatic fistula and endocrine insufficiency than duct occlusion without anastomosis. Intraperitoneal drainage after pancreatic resection is unwarranted and may contribute to intraabdominal complications. Routine use of prophylactic octreotide does not lower the rate of pancreatic fistula; it should be considered for reoperative pancreatic resection or for a soft gland. Early trials found that adjuvant chemoradiation therapy prolongs survival. But in more recent studies chemoradiation after resection has failed to show a survival advantage over surgery alone. CONCLUSIONS: Surgical resection remains the only potentially curative therapy for adenocarcinoma of the pancreas. There is no clear indication as to a single preferable resection approach. © 2003 by the American College of Surgeons.
Keywords: controlled study; treatment outcome; survival analysis; cancer surgery; surgical technique; clinical trial; review; multimodality cancer therapy; antineoplastic agents; pancreas resection; chemotherapy, adjuvant; pancreatic neoplasms; radiotherapy, adjuvant; lymph node dissection; paraaortic lymph node; prospective study; lymph node excision; evidence based medicine; evidence-based medicine; pancreaticoduodenectomy; adenocarcinoma; controlled clinical trial; randomized controlled trial; morbidity; surgical approach; standardization; randomized controlled trials; pancreas duct; pancreas adenocarcinoma; pancreatectomy; octreotide; drainage; pancreatic fistula; gastrostomy; pancreaticojejunostomy; pancreas surgery; humans; human; priority journal
Journal Title: Journal of the American College of Surgeons
Volume: 196
Issue: 6
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2003-06-01
Start Page: 954
End Page: 964
Language: English
DOI: 10.1016/s1072-7515(03)00010-3
PUBMED: 12788434
PROVIDER: scopus
Notes: Export Date: 25 September 2014 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Murray F Brennan
    782 Brennan
  2. Axel Hoos
    28 Hoos
  3. Ari D Brooks
    25 Brooks
  4. David P Jaques
    60 Jaques
  5. Kevin C Conlon
    113 Conlon