Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer
| Autor: | Mahesh Kudrimoti, Anh-Thu Le, Patrick C. McGrath, Dima Hnoosh, Bin Huang, Ching Wei D. Tzeng, Eric B. Durbin, Sean P. Dineen, Hayder Saeed, Peter J. Hosein |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Multimodality Therapy Gastroenterology Pancreaticoduodenectomy 03 medical and health sciences Postoperative Complications 0302 clinical medicine Pancreatic cancer Internal medicine medicine Adjuvant therapy Humans Major complication Neoadjuvant therapy Aged Retrospective Studies Aged 80 and over business.industry Middle Aged medicine.disease Survival Analysis Surgery Cancer registry Pancreatic Neoplasms Treatment Outcome Chemotherapy Adjuvant 030220 oncology & carcinogenesis Female Radiotherapy Adjuvant 030211 gastroenterology & hepatology business Complication Carcinoma Pancreatic Ductal Follow-Up Studies |
| Zdroj: | Journal of Surgical Research. 214:1-8 |
| ISSN: | 0022-4804 2007-2015 |
| Popis: | Although adjuvant therapy (AT) is a necessary component of multimodality therapy for pancreatic ductal adenocarcinoma (PDAC), its application can be hindered by post-pancreaticoduodenectomy (PD) complications. The primary aim of this study was to evaluate the impact of post-PD complications on AT utilization and overall survival (OS).Patients undergoing PD without neoadjuvant therapy for stages I-III PDAC at a single institution (2007-2015) were evaluated. Ninety-day postoperative major complications (PMCs) were defined as grade ≥3. Records were linked to the Kentucky Cancer Registry for AT/OS data. Early AT was given8 wk; late 8-16 wk. Initiation16 wk was not considered to be AT. Complication effects on AT timing/utilization and OS were evaluated.Of 93 consecutive patients treated with surgery upfront with AT data, 64 (69%) received AT (41 [44%] early; 23 [25%] late). There were 32 patients (34%) with low-grade complications and 24 (26%) with PMC. With PMC, only six of 24 patients (25%) received early AT and 13 of 24 (54%) received any (early/late) AT versus 35 of 69 (51%) early AT and 51 of 69 (74%) any AT without PMC. PMCs were associated with worse median OS (7.1 versus 24.6 mo, without PMC, P 0.001). Independent predictors of OS included AT (hazard ratio [HR]: 0.48), tumor2 cm (HR: 3.39), node-positivity (HR: 2.16), and PMC (HR: 3.69, all P 0.02).Independent of AT utilization and biologic factors, PMC negatively impacted OS in patients treated with surgery first. These data suggest that strategies to decrease PMC and treatment sequencing alternatives to increase multimodality therapy rates may improve oncologic outcomes for PDAC. |
| Databáze: | OpenAIRE |
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