Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Sophie L G Kollbeck; Carsten P Hansen; Emilie E Dencker; Paul S Krohn; Jan H Storkholm; Stefan K Burgdorf; Andreas S Millarch; Thomas B Piper; Jens G Hillingsø; Martin Sillesen

doi:10.1016/j.hpb.2024.11.002

Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

HPB (Oxford). 2024 Nov 9:S1365-182X(24)02390-6. doi: 10.1016/j.hpb.2024.11.002. Online ahead of print.

Affiliations

¹ Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
² Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
³ Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom.
⁴ Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark; Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark. Electronic address: [email protected].

PMID: 39603870
DOI: 10.1016/j.hpb.2024.11.002

Abstract

Introduction: Despite the benefits of surgical resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC), over 30 % of patients fail to complete adjuvant oncological treatment. Whether postoperative complications affect chemotherapy completion rates and overall survival remains uncertain. We hypothesized that postoperative complications would be associated with chemotherapy delays, omission, and reduced overall survival (OS).

Methods: This was a retrospective analysis of patients undergoing pancreaticoduodenectomy for PDAC from 2008 to 2022 to assess whether serious surgical complications, defined as Clavien Dindo Grade 3b or higher, were associated with the omission or delay of adjuvant oncologic treatment as well as OS.

Results: A total of 920 patients were available for analysis. Pancreatic and bile leakage were associated with risk of chemotherapy omission (OR 1.97 [CI 95 % 1.25-3.12], p = 0.004 and OR 1.96 [CI 95 % 1.04-3.67], p = 0.032, respectively). No delay of adjuvant chemotherapy >90 days nor change in OS was found.

Conclusion: Major surgical complications influence the likelihood of omitting adjuvant chemotherapy but not delaying it > 90 days. Patients with pancreatic or bile leakage were at greater risk of not completing planned chemotherapy but had the same OS.