Date Published: 11 July 2012

Chemotherapy after surgery and cancer survival

Recent cancer research indicates that patients who receive chemotherapy after surgery for the removal of a pancreas-related cancer have a better chance of survival than comparable patients patients who do not have that follow-up treatment.

What is periampullary cancer ?

Periampullary cancer arises from the head of the pancreas, including an area called the ampulla where the bile duct connects with the pancreatic duct to empty their secretions into the upper small intestine. Approximately 80% of these cancers can be operated on. Although chemotherapy after surgery has been shown to have a survival benefit, until recently there has been a lack of clinical studies designed to fully observe understand the impact on patients of chemotherapy after periampullary cancer.

Prof John Neoptolemos, from Liverpool University's Institute of Translational Medicine, said:

" The clinical presentation of periampullary cancer is similar to that of pancreatic ductal adenocarcinoma, and together they represent a major cause of death. We conducted a study to determine whether adjuvant chemotherapy improves overall survival following surgical removal of the cancer."

The large research team worked with data from approx 100 sites in Australia, Canada, Europe and Japan. They considered the outcomes for over 400 patients who had undergone surgery for this type of pancreas-related cancer. Sadly over half of the patients had passed-on (died) at the time of analysis.

It was found that those patients who had been treated with chemotherapy survived up to eight months longer than those who had not received that treatment. The researchers consider the "survival benefit" of chemotherapy after surgery to be statistically significant based on this research.

Prof Neoptolemos continued:

" We found a statistically significant survival benefit to chemotherapy use after surgery, but the number of deaths from these diseases is still high, even after the tumour has been removed. This research highlights the need to further improve and test combinations of chemotherapies to see if we can substantially increase survival after surgery and give patients the chance to have a good quality of life post-treatment."

Ref. to Paper:
Effect of Adjuvant Chemotherapy With Fluorouracil Plus Folinic Acid or Gemcitabine vs Observation on Survival in Patients With Resected Periampullary Adenocarcinoma: The ESPAC-3 Periampullary Cancer Randomized Trial, John P. Neoptolemos, MD et.al.; Malcolm J. Moore, MD; Trevor F. Cox, PhD; Juan W. Valle, MD; Daniel H. Palmer, MD; Alexander C. McDonald, MD; Ross Carter, MD; Niall C. Tebbutt, PhD; Christos Dervenis, MD; David Smith, MD; Bengt Glimelius, MD; Richard M. Charnley, MD; François Lacaine, MD; Andrew G. Scarfe, MD; Mark R. Middleton, MD; Alan Anthoney, MD; Paula Ghaneh, MD; Christopher M. Halloran, MD; Markus M. Lerch, MD; Attila Oláh, MD; Charlotte L. Rawcliffe, MSc; Caroline S. Verbeke, MD, FRCPath; Fiona Campbell, MD, FRCPath; Markus W. Büchler, MD; Pub by The Journal of the American Medical Association, JAMA. 2012;308(2):147-156. doi:10.1001/jama.2012.7352 . Weblink http://bit.ly/LXJHu6

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