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Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Would high-risk patients benefit from neoadjuvant therapy?

Published:August 30, 2022DOI:https://doi.org/10.1016/j.ejso.2022.08.032

      Abstract

      Introduction

      Patients who suffer a serious complication of pancreatoduodenectomy (PD) may have their adjuvant chemotherapy (AC) delayed or omitted as a result. We aimed to investigate whether PD complications affected AC rates.

      Materials and methods

      A retrospective analysis of all PD patients with histologically-confirmed pancreatic ductal adenocarcinoma (2006–2015) was performed; 90-day mortality patients were excluded. Patients who commenced AC were compared to those who did not (morbidity rates and survival) and patients who developed selected postoperative complications were compared to those who did not (AC rates and survival).

      Results

      157 patients were included and 90-day mortality was 3.8%. Of the remaining patients, 102 (68.5%) received AC (AC data unavailable for two patients). Survival was longer in the AC group (p = 0.004). AC patients had less frequently experienced a postoperative chest infection (8.82% vs 34.0%, p = 0.0003) or a postoperative complication which was Clavien-Dindo (CD) grade ≥ II (29.4% vs 57.4%, p = 0.0019) or ≥ III (6.86% vs 21.3%, p = 0.023). Patients who experienced a postoperative chest infection (36.0% vs 75.0%, p = 0.0003) or a postoperative complication which was CD grade ≥ II (48.9% vs 73.1%, p = 0.0099) or ≥ III (29.4% vs 70.3%, p = 0.0018) less frequently commenced AC.

      Conclusion

      Patients who received AC had less frequently experienced a serious postoperative complication. Efforts should be made to preoperatively identify those who are high-risk for a serious complication as this cohort may benefit from neoadjuvant therapy.

      Keywords

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      References

        • Neoptolemos J.P.
        • et al.
        A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer.
        N Engl J Med. 2004; 350: 1200-1210
        • Nienhuijs S.W.
        • et al.
        Nationwide improvement of only short-term survival after resection for pancreatic cancer in The Netherlands.
        Pancreas. 2012; 41: 1063-1066
        • Crippa S.
        • et al.
        Recurrence after surgical resection of pancreatic cancer: the importance of postoperative complications beyond tumor biology.
        HPB. 2021; 23: 1666-1673
        • Sohal D.P.S.
        • et al.
        Pancreatic adenocarcinoma: improving prevention and survivorship.
        Am Soc Clin Oncol Educ Book. 2017; 37: 301-310
        • Bassi C.
        • et al.
        The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.
        Surgery. 2017; 161: 584-591
        • Brooke-Smith M.
        • et al.
        Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study.
        HPB : Off J Int Hapato Pancreato Biliary Assoc. 2015; 17: 46-51
        • Wente M.N.
        • et al.
        Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition.
        Surgery. 2007; 142: 20-25
        • Wente M.N.
        • et al.
        Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).
        Surgery. 2007; 142: 761-768
        • Clavien P.A.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Yamashita Y.-I.
        • et al.
        Surgical results of pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a multi-institutional retrospective study of 174 patients.
        Anticancer Res. 2016; 36: 2407
        • Wiltberger G.
        • et al.
        Preoperative risk stratification for major complications following pancreaticoduodenectomy: identification of high-risk patients.
        Int J Surg. 2016; 31: 33-39
        • Narayanan S.
        • et al.
        Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death.
        J Surg Res. 2018; 231: 304-308
        • Hsu C.-P.
        • et al.
        Three-year and five-year outcomes of surgical resection for pancreatic ductal adenocarcinoma: long-term experiences in one medical center.
        Asian J Surg. 2018; 41: 115-123
        • Luu A.M.
        • et al.
        Long-term survival after pancreaticoduodenectomy in patients with ductal adenocarcinoma of the pancreatic head.
        Hepatobiliary Pancreat Dis Int. 2021; 20: 271-278
        • Williamsson C.
        • et al.
        Predictive factors for postoperative pancreatic fistula—a Swedish nationwide register-based study.
        World J Surg. 2020; 44: 4207-4213
        • Ke Z.X.
        • et al.
        Risk factors and management of postoperative pancreatic fistula following pancreaticoduodenectomy: single-center experience.
        Curr Med Sci. 2019; 39: 1009-1018
        • Andrianello S.
        • et al.
        Biliary fistula after pancreaticoduodenectomy: data from 1618 consecutive pancreaticoduodenectomies.
        HPB. 2017; 19: 264-269
        • Labori K.J.
        • et al.
        Gastro- or duodenojejunostomy leaks after pancreatoduodenectomy: single center experience and narrative literature review.
        J Gastrointest Surg. 2021; 25: 3130-3136
        • Kasumova G.G.
        • et al.
        Hemorrhage after pancreaticoduodenectomy: does timing matter?.
        HPB : Off J Int Hapato Pancreato Biliary Assoc. 2016; 18: 861-869
        • Varghese C.
        • et al.
        Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials.
        BJS Open. 2021; 5
        • Suragul W.
        • et al.
        Predictors of surgical site infection after pancreaticoduodenectomy.
        BMC Gastroenterol. 2020; 20: 201
        • Nagle R.T.
        • et al.
        Pneumonia is associated with a high risk of mortality after pancreaticoduodenectomy.
        Surgery. 2017; 161: 959-967
        • Sato N.
        • et al.
        Early intra-abdominal infection following pancreaticoduodenectomy:associated factors and clinical impact on surgical outcome.
        Fukushima J Med Sci. 2020; 66: 124-132
        • Zhao N.
        • et al.
        Natural history and therapeutic strategies of post-pancreatoduodenectomy abdominal fluid collections: ten-year experience in a single institution.
        Medicine. 2019; 98 (e15792-e15792)
        • Klaiber U.
        • Hackert T.
        • Neoptolemos J.P.
        Adjuvant treatment for pancreatic cancer.
        Trans. Gastroenterol Hepatol. 2019; 4 (27-27)
        • Neoptolemos J.P.
        • et al.
        ESPAC-1 trial progress report: the European randomized adjuvant study comparing radiochemotherapy, 6 months chemotherapy and combination therapy versus observation in pancreatic cancer.
        Digestion. 1997; 58: 570-577
        • Neoptolemos J.P.
        • et al.
        Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.
        Lancet. 2017; 389: 1011-1024
        • Valle J.W.
        • et al.
        Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study.
        J Clin Oncol. 2014; 32: 504-512
        • Ma S.J.
        • et al.
        Association of timing of adjuvant therapy with survival in patients with resected stage I to II pancreatic cancer.
        JAMA Netw Open. 2019; 2 (e199126-e199126)
        • Reni M.
        • et al.
        Safety and efficacy of preoperative or postoperative chemotherapy for resectable pancreatic adenocarcinoma (PACT-15): a randomised, open-label, phase 2–3 trial.
        Lancent Gastroenterol Hepatol. 2018; 3: 413-423
        • van Dijk S.M.
        • et al.
        Systematic review on the impact of pancreatoduodenectomy on quality of life in patients with pancreatic cancer.
        HPB. 2018; 20: 204-215