Introduction: Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pan-creatoduodenectomy (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.(c) 2023 Published by Elsevier Ltd.
Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study / Russell, Thomas B.; Labib, Peter L.; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith J.; Kausar, Ambareen; Mavroeidis, Vasileios K.; Marangoni, Gabriele; Thomasset, Sarah C.; Frampton, Adam E.; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M.; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R.; Bhogal, Ricky H.; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; Gomez, Dhanny; Silva, Michael A.; Lapolla, Pierfrancesco; Mingoli, Andrea; Porcu, Alberto; Shah, Nehal S.; Hamady, Zaed Z. R.; Al-Sarrieh, Bilal; Serrablo, Alejandro; Aroori, Somaiah; Labib, Peter L.; Russell, Thomas B.; Streeter, Adam; Denson, Jemimah; Puckett, Mark; Zhou, Shang-Ming; Browning, Matthew; Aroori, Somaiah; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith; Kausar, Ambareen; Mavroeidis, Vasileios K.; Marangoni, Gabriele; Thomasset, Sarah; Frampton, Adam; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian; Bhogal, Ricky; Croagh, Daniel; Dominguez, Ismael; Thakkar, Rohan; Gomez, Dhanny; Silva, Michael; Lapolla, Pierfrancesco; Mingoli, Andrea; Porcu, Alberto; Shah, Nehal Sureshkumar; Hamady, Zaed; Al-Sarrieh, Bilal; Serrablo, Alejandro; Gonzalez-Abos, Carolina; Fernandes, Nair; Moller, Elsa Garcia; Taboada, Cristina Dopazo; Pande, Rupaly; Alfarah, Jameel; Bandyopadhyay, Samik; Abdelrahim, Ahmed; Khan, Ayesha; Jordan, Caitlin; Rees, Jonathan R. E.; Blege, Harry; Cambridge, William; White, Olga; Blacker, Sarah; Blackburn, Jessie; Sweeney, Casie; Field, Daniel; Gouda, Mohammed; Bellotti, Ruben; Hamid, Hytham K. S.; Ahmed, Hassan; Moriarty, Catherine; White, Louise; Priestley, Mark; Bode, Kerry; Sharp, Judith; Wragg, Rosie; Jackson, Beverley; Craven, Samuel; Fehervari, Matyas; Pai, Madhava; Alghazawi, Laith; Onifade, Anjola; Ribaud, Julliette; Nair, Ashitha; Mariathasan, Michael; Grayson, Niamh; Pericleous, Stephanos; Patel, Krishna; Shaw, Conrad; Morare, Nolitha; Zaban, Mohamad Khish; Doyle, Joseph; Mavroeidis, Vasileios K.; Guerrero, Alan; Moguel, Andre; Chan, Carlos; Jones, Michael; Buckley, Edward; Akter, Nasreen; Treherne, Kyle; Gordon, Gregory; Hughes, Daniel; Urbonas, Tomas; Brachini, Gioia; Caronna, Roberto; Chirletti, Piero; Perra, Teresa; Abd Kahar, Nurul Nadhirah; Hall, Thomas; Nadeem, Nabeegh; Karar, Shoura; Arshad, Ali; Yarwood, Adam; Hammoda, Mohammed; Artigas, Maria; Paterna-López, Sandra. - In: EUROPEAN JOURNAL OF SURGICAL ONCOLOGY. - ISSN 0748-7983. - 49:9(2023). [10.1016/j.ejso.2023.04.018]
Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study
Lapolla, Pierfrancesco;Mingoli, Andrea;Smith, Andrew;Lapolla, Pierfrancesco;Mingoli, Andrea;Abdelrahim, Ahmed;Brachini, Gioia;Caronna, Roberto;Chirletti, Piero;
2023
Abstract
Introduction: Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pan-creatoduodenectomy (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.(c) 2023 Published by Elsevier Ltd.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
