Justifying vein resection with pancreatoduodenectomy - Author's reply

Savio G. Barreto, John A. Windsor

Research output: Contribution to journalLetterpeer-review

5 Citations (Scopus)


Stefano Crippa and colleagues, in responding to our manuscript, agree that increasing the radicality of surgery for pancreatic ductal adenocarcinoma, including synchronous vein resection, is suspect. Indeed, a recent meta-analysis indicates that synchronous vein resection, as reported, increases mortality and decreases survival. Crippa and colleagues put forward two interesting ideas that warrant further discussion. The first is that the surgery-first approach for pancreatic ductal adenocarcinoma might ultimately be retired, given that pancreatic ductal adenocarcinoma is usually systemic at presentation, local treatments have little effect, and neoadjuvant therapy has possible benefits. For now, the absence of high-level evidence for neoadjuvant therapy leaves largely theoretical benefits; namely that neoadjuvant therapy will reveal the biology (ie, those patients that can progress on neoadjuvant therapy will avoid futile surgery), or alter the biology (ie, those patients that are downstaged will become resectable). The preliminary results of the ALLIANCE trial damages the lustre of these purported benefits with no improvement in the number of resections...
Original languageEnglish
Pages (from-to)e178
Number of pages1
JournalLancet Oncology
Issue number5
Early online date27 Apr 2016
Publication statusPublished - 1 May 2016
Externally publishedYes


  • pancreatoduodenectomy
  • Neoadjuvant therapy
  • radical surgery


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