Annals of Surgical Oncology

, Volume 25, Issue 3, pp 626–637 | Cite as

Neoadjuvant Therapy Versus Upfront Resection for Pancreatic Cancer: The Actual Spectrum and Clinical Burden of Postoperative Complications

  • Giovanni Marchegiani
  • Stefano Andrianello
  • Chiara Nessi
  • Marta Sandini
  • Laura Maggino
  • Giuseppe Malleo
  • Salvatore Paiella
  • Enrico Polati
  • Claudio Bassi
  • Roberto Salvia
Pancreatic Tumors



Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications.


We analyzed 445 pancreatic resections for PDAC from 2014 to 2016 at The Pancreas Institute, Verona University Hospital. The Modified Accordion Severity Grading System and average complication burden (ACB) were used to compare patients treated with NAT with patients who underwent upfront surgery (UFS).


Of 305 pancreaticoduodenectomies (PD), patients treated with NAT (n = 99) had less pancreatic fistula (POPF, 9.1% vs. 15.6%, p = 0.05) without grade C cases, but grade B ACB was increased (0.28 for NAT vs. 0.24 for UFS, p = 0.05). The postpancreatectomy hemorrhage (PPH) rate was lower in the NAT group (9.1% vs. 14.6%, p = 0.02), but ACB grades B (0.37 for NAT vs. 0.26 for UFS, p = 0.03) and C (0.43 for NAT vs. 0.29 for UFS, p = 0.05) were increased. Delayed gastric emptying (DGE) was increased in NAT cases (15.2% vs. 8.3%, p = 0.04), with higher grade C ACB (0.43 for NAT vs. 0.29 for UFS, p = 0.03). Of 94 distal pancreatectomies (DP), NAT patients (n = 26) developed more grade C POPF (11.5% vs. 1.5%, p = 0.04) and DGE (11.5% vs. 2.9%, p = 0.01) without differences in ACB.


Patients undergoing PD for PDAC after NAT exhibited reduced incidence of POPF and PPH but increased incidence of DGE compared with patients treated with UFS. Among patients developing postoperative complications after PD, those receiving NAT were associated with increased clinical burden.


Pancreatic cancer Neoadjuvant therapy FOLFIRINOX Pancreaticoduodenectomy Pancreatic fistula Outcome 



This work was supported by Associazione Italiana Ricerca Cancro (AIRC n.12182 and n.17132), Italian Ministry of Health (FIMP-CUP_J33G13000210001), and FP7 European Community Grant Cam-Pac (n. 602783). The funding agencies had no role in the collection, analysis or interpretation of data or writing of the manuscript.

Conflict of interest

The authors declares that they have no competing interest.

Supplementary material

10434_2017_6281_MOESM1_ESM.docx (96 kb)
Supplementary material 1 (DOCX 96 kb)
10434_2017_6281_MOESM2_ESM.docx (76 kb)
Supplementary material 2 (DOCX 75 kb)


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Giovanni Marchegiani
    • 1
  • Stefano Andrianello
    • 1
  • Chiara Nessi
    • 1
  • Marta Sandini
    • 2
  • Laura Maggino
    • 1
  • Giuseppe Malleo
    • 1
  • Salvatore Paiella
    • 1
  • Enrico Polati
    • 3
  • Claudio Bassi
    • 1
  • Roberto Salvia
    • 1
  1. 1.Department of General and Pancreatic Surgery – The Pancreas InstituteUniversity of Verona Hospital TrustVeronaItaly
  2. 2.Department of SurgeryMilano-Bicocca University, San Gerardo HospitalMonzaItaly
  3. 3.Department of Anesthesia and Intensive Care UnitUniversity of Verona Hospital TrustVeronaItaly

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