
    no accrual rate
  
['pancreatic neoplasms', 'pancreatic adenocarcinoma']
['gemcitabine']

        Inclusion Criteria:

          -  Primary diagnosis of pancreatic ductal adenocarcinoma (PDAC) confined to the head of
             the pancreas classified as T1-T3 with one or more of the following high-risk clinical
             features:

               -  Carbohydrate antigen (CA) 19-9 greater than 1,000 U/mL with a normal bilirubin;

               -  Vascular involvement; and/or

               -  Suspicious regional lymphadenopathy

          -  Intention to undergo open pancreaticoduodenectomy (standard Whipple or
             pylorus-preserving pancreaticoduodenectomy) as treatment for PDAC

          -  Adequate clinical condition to undergo preoperative (neoadjuvant) hyperthermic
             intraperitoneal chemotherapy

          -  Adequate clinical condition to undergo perioperative systemic chemotherapy

          -  White blood cell count of at least 3000/mL

          -  Platelet count of at least 100,000/mL

          -  Normal creatinine (< 2 mg/dL) or creatinine clearance of at least 50 mL/min

          -  Willing and able to give informed consent

        Exclusion Criteria:

          -  Evidence of locoregional spread (carcinomatosis of peritoneal surfaces, mesenteric
             arteries, or body/tail of pancreas) or distant (liver, lung, or other) metastases
             (histological, CT, or MRI confirmation)

          -  Non-curative intent of treatment (≥R2 resection)

          -  Body mass index (BMI) > 35

          -  Previous history of pancreatic resections for tumors in the body and/or tail of the
             pancreas, distal cholangiocarcinoma, duodenal carcinoma, neuroendocrine tumors,
             cyst-adenocarcinoma, or solid and papillary tumors.

          -  Unstable or uncompensated respiratory or cardiac disease

          -  Severe hepatic or renal dysfunction

          -  Bleeding diathesis or coagulopathy

          -  Pregnant or nursing women
      