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Master Thesis

Traitement néoadjuvant dans le cancer du pancréas : pour quels résultats et à quel prix ? Expérience bordelaise de 85 patients sur 10 ans

Abstract : Background: Several studies suggested the benefit of neoadjuvant (NA) treatment for locally advanced or borderline pancreatic adenocarcinoma. The main objective of this study is to evaluate the impact of NA treatment on perioperative morbidity, histology, and survival. Methods: From January 2004 to December 2013, all patients who underwent a duodenopancreatectomy for pancreatic adenocarcinoma in Bordeaux University Hospital were retrospectively reviewed. The study focused on patients who had primary neoadjuvant treatment before duodenopancreatectomy (NA group). Control group consisted in patients who had only surgery. Results: Eighty-five patients had duodenopancreatectomy after NA treatment - generally chemotherapy followed by radiochemotherapy. Twenty-five patients had initial FOLFIRINOX and 42 patients had gemcitabine-based chemotherapy. The control group included 115 patients. Operative time was higher in the NA group (6:00 vs 5:00) with higher rate of venous resection (37.6 % vs 20.9%). Postoperative complications, especially rate and severity of postoperative haemorrage and pancreatic fistulas, did not differ in both groups. Twelve patients in NA group had complete pathologic response. Proportion of pT3/T4 (control : 91,3 % vs NA : 65,9%), peri-nervous engainement (control : 73,9% vs NA : 55,3%), and lymphovascular invasion (control : 57,4% vs NA : 22,3%) were significantly higher in the control group compared to NA group. Disease-free and overall survival were similar in both group, but disease-free survival in patients of the NA group treated with FOLFIRINOX seemed to be superior. Conclusion: NA therapy, especially FOLFIRINOX-based chemotherapy, seems to improve disease-free survival without increasing perioperative morbidity. These data should be confirmed by a prospective randomized study for patients with primary resecable tumors.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01218661
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Wednesday, October 21, 2015 - 3:16:30 PM
Last modification on : Friday, October 23, 2020 - 5:02:47 PM
Long-term archiving on: : Saturday, January 23, 2016 - 12:42:19 AM

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Pauline Jaffrezic. Traitement néoadjuvant dans le cancer du pancréas : pour quels résultats et à quel prix ? Expérience bordelaise de 85 patients sur 10 ans. Médecine humaine et pathologie. 2015. ⟨dumas-01218661⟩

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