ABSTRACT
BACKGROUND: As the incidence of pancreatic adenocarcinoma increases, so has the utilization of neoadjuvant therapy. The objective of this study was to evaluate outcomes in patients undergoing neoadjuvant therapy or surgery first for pancreatic adenocarcinoma. METHODS: The ACS-NSQIP 2014-2015 targeted pancreatectomy variables were queried for patients with pancreatic adenocarcinoma who underwent resection. Outcomes of those receiving neoadjuvant therapy were compared to surgery first using a multivariate, logistic regression model. RESULTS: 3408 patients underwent pancreatectomy; 2596 proximal pancreatectomies, 741 distal pancreatectomies, 64 total pancreatectomies and 7 other pancreatic procedures were performed. Of the 3408 patients identified, 934 (27.5%) received neoadjuvant therapy: 496 chemotherapy alone, 28 radiation alone, and 410 combined chemotherapy/radiation therapy. Overall morbidity and mortality were similar between patients receiving neoadjuvant therapy versus those who underwent surgery first. Neoadjuvant treatment was associated with lower rates of pancreatic fistulas (10.2% vs. 13.2%, P = 0.017), but higher intra/postoperative transfusion rates (27.4% vs. 20.3%, P < 0.0001). CONCLUSIONS: Neoadjuvant therapy appeared to be safe prior to operative intervention as no difference in overall postoperative morbidity or mortality rates were identified. There were increased intra/postoperative transfusions in the neoadjuvant therapy group, but neoadjuvant therapy was associated with lower rates of pancreatic fistulas.
Subject(s)
Adenocarcinoma/therapy , Neoadjuvant Therapy , Pancreatectomy , Pancreatic Neoplasms/therapy , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Aged , Blood Loss, Surgical/prevention & control , Blood Transfusion , Chemoradiotherapy, Adjuvant , Chemotherapy, Adjuvant , Databases, Factual , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Neoadjuvant Therapy/adverse effects , Neoadjuvant Therapy/mortality , Odds Ratio , Pancreatectomy/adverse effects , Pancreatic Fistula/etiology , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/prevention & control , Radiotherapy, Adjuvant , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , United StatesABSTRACT
BACKGROUND: Magnetic sphincter augmentation (MSA) is FDA approved for the surgical treatment of GERD. While multiple reports from academic settings exist, we report the early experience from two community-based health systems. METHODS: The first 102 post-trial cases of MSA were reviewed. Outcomes were compared to those in the initial clinical trial. RESULTS: Mean follow-up duration was 7.6 months. GERD medication use decreased from 98% preoperative to 8% postoperative (P<0.001). Median GERD health-related quality of life (HRQL) improved from 27 preoperative to 5 postoperative (P<0.001). Patient satisfaction increased from 8% preoperative to 84% postoperative (P<0.001). Results were similar to the trial data. CONCLUSIONS: MSA is a safe and effective treatment for GERD, with significant improvement in quality of life. GERD-HRQL, medication reduction, operative times, and dysphagia rates were similar to other reports, demonstrating the reproducibility of MSA. Lower dilation rates may be due to refinements in technique and postoperative dietary management.
