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Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

2023; Elsevier BV; Volume: 49; Issue: 9 Linguagem: Inglês

10.1016/j.ejso.2023.04.018

1532-2157

Thomas Russell, Peter Labib, Fabio Ausania, Elizabeth Pando, Keith Roberts, Ambareen Kausar, Vasileios Mavroeidis, Gabriele Marangoni, Sarah Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Domínguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal Shah, Zaed Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori, Peter Labib, Thomas Russell, Adam Streeter, Jemimah Denson, Mark Puckett, Shang‐Ming Zhou, Matthew G. Browning, Somaiah Aroori, Fabio Ausania, Elizabeth Pando, Keith Roberts, Ambareen Kausar, Vasileios Mavroeidis, Gabriele Marangoni, Sarah Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Domínguez, Rohan Thakkar, Dhanny Gomez, Michael Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal Sureshkumar Shah, Zaed Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Carolina González‐Abós, Nair Fernandes, Elsa Garcia Moller, Cristina Dopazo Taboada, Rupaly Pandé, Jameel Alfarah, Samik Bandyopadhyay, Ahmed Abdel-Rahim, Ayesha Khan, Caitlin Jordan, Jonathan Rees, Harry Blege, William Cambridge, Olga White, Sarah Blacker, Jessie Blackburn, Casie Sweeney, Daniel J. Field, Mohammed Gouda, Ruben Bellotti, Hytham K. S. Hamid, Hassan Ahmed, Catherine Moriarty, Louise G. White, Mark Priestley, Kerry Bode, J. A. Sharp, Rosie Wragg, Beverley Jackson, Samuel Craven, Matyas Fehervari, Madhava Pai, Laith Alghazawi, Anjola Onifade, Julliette Ribaud, Ashitha Nair, Michael Mariathasan, Niamh Grayson, Stephanos Pericleous, Krishna Patel, Conrad Shaw, Nolitha Morare, Mohamad Khish Zaban, Joseph Doyle, Vasileios Mavroeidis, Alan Guerrero, Andre Moguel, Carlos H.F. Chan, Michael Jones, Edward G. Buckley, Nasreen Akter, Kyle Treherne, Gregory S. Gordon, Daniel Hughes, Tomas Urbonas, Gioia Brachini, Roberto Caronna, Piero Chirletti, Teresa Perra, Nurul Nadhirah Abd Kahar, Thomas E. Hall, Nabeegh Nadeem, Shoura Karar, Ali Arshad, Adam Yarwood, Mohammed Hammoda, María Soler Artigas, Sandra Paterna-López,

Neuroendocrine Tumor Research Advances

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.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.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).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.