TY - JOUR
T1 - Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy:
T2 - Results from the recurrence after Whipple's (RAW) study
AU - Russell, Thomas B
AU - Labib, Peter L
AU - Ausania, Fabio
AU - Pando, Elizabeth
AU - Roberts, Keith J
AU - Kausar, Ambareen
AU - Mavroeidis, Vasileios K
AU - Marangoni, Gabriele
AU - Thomasset, Sarah C
AU - Frampton, Adam E
AU - Lykoudis, Pavlos
AU - Maglione, Manuel
AU - Alhaboob, Nassir
AU - Bari, Hassaan
AU - Smith, Andrew M
AU - Spalding, Duncan
AU - Srinivasan, Parthi
AU - Davidson, Brian R
AU - Bhogal, Ricky H
AU - Croagh, Daniel
AU - Dominguez, Ismael
AU - Thakkar, Rohan
AU - Gomez, Dhanny
AU - Silva, Michael A
AU - Lapolla, Pierfrancesco
AU - Mingoli, Andrea
AU - Porcu, Alberto
AU - Shah, Nehal S
AU - Hamady, Zaed Z R
AU - Al-Sarrieh, Bilal
AU - Serrablo, Alejandro
AU - Aroori, Somaiah
N1 - Publisher Copyright:
© 2023
PY - 2023/9
Y1 - 2023/9
N2 - Introduction: Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS. Materials and methods: Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests. Results: Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74% vs 63%, p = 0.004) and had less often experienced a serious postoperative complication (10% vs 18%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52% vs 73%, p = 0.0004) and less often commenced AC (58% vs 74%, p = 0.002). Conclusion: In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.
AB - Introduction: Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS. Materials and methods: Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests. Results: Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74% vs 63%, p = 0.004) and had less often experienced a serious postoperative complication (10% vs 18%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52% vs 73%, p = 0.0004) and less often commenced AC (58% vs 74%, p = 0.002). Conclusion: In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.
KW - Adjuvant chemotherapy
KW - Morbidity
KW - Neoadjuvant therapy
KW - Pancreatic ductal carcinoma
KW - Pancreaticoduodenectomy
KW - Postoperative complications
KW - Adjuvant chemotherapy
KW - Morbidity
KW - Neoadjuvant therapy
KW - Pancreatic ductal carcinoma
KW - Pancreaticoduodenectomy
KW - Postoperative complications
KW - Adjuvant chemotherapy
KW - Morbidity
KW - Neoadjuvant therapy
KW - Pancreatic ductal carcinoma
KW - Pancreaticoduodenectomy
KW - Postoperative complications
KW - Humans
KW - Carcinoma, Pancreatic Ductal/drug therapy
KW - Pancreaticoduodenectomy/adverse effects
KW - Neoplasm Recurrence, Local/drug therapy
KW - Postoperative Complications/epidemiology
KW - Retrospective Studies
KW - Chemotherapy, Adjuvant
KW - Pancreatic Neoplasms/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85162122993&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/f4277b51-0408-3b2c-9d5f-8505fab63277/
U2 - 10.1016/j.ejso.2023.04.018
DO - 10.1016/j.ejso.2023.04.018
M3 - Article
C2 - 37330348
SN - 0305-7399
VL - 49
SP - 106919
JO - Clinical Oncology
JF - Clinical Oncology
IS - 9
M1 - 106919
ER -