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Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several international high-volume centers have reported good outcomes after resection of locally advanced pancreatic cancer (LAPC) following chemo(radio)therapy, but it is unclear how this translates to nationwide clinical practice and outcome. This study aims to assess the nationwide use and outcome of resection of LAPC following induction chemo(radio)therapy.

Patients and Methods

A multicenter retrospective study including all patients who underwent resection for LAPC following chemo(radio)therapy in all 16 Dutch pancreatic surgery centers (2014–2020), registered in the mandatory Dutch Pancreatic Cancer Audit. LAPC is defined as arterial involvement > 90° and/or portomesenteric venous > 270° involvement or occlusion.

Results

Overall, 142 patients underwent resection for LAPC, of whom 34.5% met the 2022 National Comprehensive Cancer Network criteria. FOLFIRINOX was the most commonly (93.7%) used chemotherapy [median 5 cycles (IQR 4–8)]. Venous and arterial resections were performed in 51.4% and 14.8% of patients. Most resections (73.9%) were performed in high-volume centers (i.e., ≥ 60 pancreatoduodenectomies/year). Overall median volume of LAPC resections/center was 4 (IQR 1–7). In-hospital/30-day major morbidity was 37.3% and 90-day mortality was 4.2%. Median OS from diagnosis was 26 months (95% CI 23–28) and 5-year OS 18%. Surgery in high-volume centers [HR = 0.542 (95% CI 0.318–0.923)], ypN1-2 [HR = 3.141 (95% CI 1.886–5.234)], and major morbidity [HR = 2.031 (95% CI 1.272–3.244)] were associated with OS.

Conclusions

Resection of LAPC following chemo(radio)therapy is infrequently performed in the Netherlands, albeit with acceptable morbidity, mortality, and OS. Given these findings, a structured nationwide approach involving international centers of excellence would be needed to improve selection of patients with LAPC for surgical resection following induction therapy.

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Acknowledgements

For the Dutch Pancreatic Cancer Group collaborators: Anniek Vlijm, MD, PhD; Bert A. Bonsing, MD, PhD; C. Yung Nio, MD, PhD; Derik-Jan de Groot, MD, PhD; Elske Gootjes, MD, PhD; Eran van Veldhuisen, MD, PhD; Eric Manusama, MD, PhD; Fenny Wit, MD, PhD; Freek Daams, MD, PhD; Geert Cirkel, MD, PhD; Geertjan van Tienhoven, MD, PhD; Irene van Hellemond, MD, PhD; Johanna W. Wilmink, MD, PhD; Judith de Vos-Geelen, MD, PhD; Koop Bosscha, MD, PhD; Leonie J. Mekenkamp, MD, PhD; Maarten W. Nijkamp, MD, PhD; Maartje Los, MD, PhD; Marion B. van der Kolk, MD, PhD; Marjolein Homs, MD, PhD; Mark Ramaekers, MD; Mike S. Liem, MD, PhD; Miriam Wumkes, MD, PhD; Nynke Michiels, MD; Ronald van Dam, MD, PhD; Rutger T. Theijse, BSc; Saskia Luelmo, MD, PhD; Thomas L. Bollen, MD, PhD; Ulf Neumann, MD, PhD; Vincent Nieuwenhuijs, MD, PhD; Werner Draaisma, MD, PhD

Author information

Author notes

  1. Thomas F. Stoop, Leonard W. F. Seelen and Freek R. van ‘t Land are shared first author.

Authors and Affiliations

  1. Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands

    Thomas F. Stoop MD, Kishan R. D. Lutchman BSc, Susan van Dieren MSc, PhD, Joris I. Erdmann MD, PhD, Olivier R. Busch MD, PhD & Marc G. Besselink MD, MSc, PhD

  2. Cancer Center Amsterdam, Amsterdam, The Netherlands

    Thomas F. Stoop MD, Kishan R. D. Lutchman BSc, Susan van Dieren MSc, PhD, Geert Kazemier MD, PhD, Joris I. Erdmann MD, PhD, Olivier R. Busch MD, PhD & Marc G. Besselink MD, MSc, PhD

  3. Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Thomas F. Stoop MD

  4. Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht/St. Antonius Hospital Nieuwegein, Utrecht, Nieuwegein, The Netherlands

    Leonard W. F. Seelen MD, Wouter te Riele MD, PhD, I. Quintus Molenaar MD, PhD & Hjalmar C. van Santvoort MD, PhD

  5. Department of Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands

    Freek R. van ’t Land MD, Bas Groot Koerkamp MD, PhD, Roeland F. de Wilde MD, PhD & Casper H. J. van Eijck MD, PhD

  6. Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands

    Daan J. Lips MD, PhD

  7. Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands

    Erwin van der Harst MD, PhD

  8. Amsterdam UMC, Location Vrije University, Department of Surgery, Amsterdam, The Netherlands

    Geert Kazemier MD, PhD

  9. Department of Surgery, Isala Clinics, Zwolle, The Netherlands

    Gijs A. Patijn MD, PhD

  10. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Ignace H. de Hingh MD, PhD

  11. Department of Surgery, Amphia Hospital, Breda, The Netherlands

    Jan H. Wijsman MD, PhD

  12. Department of Surgery, OLVG, Amsterdam, The Netherlands

    Sebastiaan Festen MD, PhD

  13. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    J. Sven D. Mieog MD, PhD

  14. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Marcel den Dulk MD, PhD

  15. Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany

    Marcel den Dulk MD, PhD

  16. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

    Martijn W. J. Stommel MD, PhD

  17. Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands

    Vincent E. de Meijer MD, PhD

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  1. Thomas F. Stoop MD
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  2. Leonard W. F. Seelen MD
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  3. Freek R. van ’t Land MD
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  25. Marc G. Besselink MD, MSc, PhD
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Consortia

for the Dutch Pancreatic Cancer Group

  • Anniek Vlijm MD, PhD
  • , Bert A. Bonsing MD, PhD
  • , C. Yung Nio MD, PhD
  • , Derik-Jan de Groot MD, PhD
  • , Elske Gootjes MD, PhD
  • , Eran van Veldhuisen MD, PhD
  • , Eric Manusama MD, PhD
  • , Fenny Wit MD, PhD
  • , Freek Daams MD, PhD
  • , Geert Cirkel MD, PhD
  • , Geertjan van Tienhoven MD, PhD
  • , Irene van Hellemond MD, PhD
  • , Johanna W. Wilmink MD, PhD
  • , Judith de Vos-Geelen MD, PhD
  • , Koop Bosscha MD, PhD
  • , Leonie J. Mekenkamp MD, PhD
  • , Maarten W. Nijkamp MD, PhD
  • , Maartje Los MD, PhD
  • , Marion B. van der Kolk MD, PhD
  • , Marjolein Homs MD, PhD
  • , Mark Ramaekers MD
  • , Mike S. Liem MD, PhD
  • , Miriam Wumkes MD, PhD
  • , Nynke Michiels MD
  • , Ronald van Dam MD, PhD
  • , Rutger T. Theijse BSc
  • , Saskia Luelmo MD, PhD
  • , Thomas L. Bollen MD, PhD
  • , Ulf Neumann MD, PhD
  • , Vincent Nieuwenhuijs MD, PhD
  •  & Werner Draaisma MD, PhD

Corresponding authors

Correspondence to Thomas F. Stoop MD or Marc G. Besselink MD, MSc, PhD.

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Disclosure

Thomas F. Stoop, Casper H.J. van Eijck, Hjalmar C. van Santvoort, and Marc G. Besselink received two grants from Dutch Cancer Society (KWF) and Deltaplan Alvleesklierkanker for the Dutch PREOPANC-4 project on the multidisciplinary management of LAPC. Furthermore, Thomas F. Stoop is granted by Prins Bernhard Cultuurfonds (Jan de Ruijsscher/Pia Huisman Fonds).

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Stoop, T.F., Seelen, L.W.F., van ’t Land, F.R. et al. Nationwide Use and Outcome of Surgery for Locally Advanced Pancreatic Cancer Following Induction Chemotherapy. Ann Surg Oncol 31, 2640–2653 (2024). https://doi.org/10.1245/s10434-023-14650-6

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  • DOI: https://doi.org/10.1245/s10434-023-14650-6

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