PMID- 37210446
OWN - NLM
STAT- MEDLINE
DCOM- 20230707
LR  - 20240102
IS  - 1534-4681 (Electronic)
IS  - 1068-9265 (Linking)
VI  - 30
IP  - 8
DP  - 2023 Aug
TI  - Major Postoperative Complications Limit Adjuvant Therapy Administration in 
      Patients Undergoing Pancreatoduodenectomy for Distal Cholangiocarcinoma or 
      Pancreatic Ductal Adenocarcinoma.
PG  - 5027-5034
LID - 10.1245/s10434-023-13533-0 [doi]
AB  - INTRODUCTION: Guidelines for perioperative systemic therapy administration in 
      patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma (PDAC) 
      and distal cholangiocarcinoma (dCCA) are evolving. Decisions regarding adjuvant 
      therapy are influenced by postoperative morbidity, which is common after 
      pancreatoduodenectomy. We evaluated whether postoperative complications are 
      associated with receipt of adjuvant therapy after pancreatoduodenectomy. METHODS: 
      A retrospective analysis of patients undergoing pancreatoduodenectomy for PDAC or 
      dCCA from 2015 to 2020 was conducted. Demographic, clinicopathologic, and 
      postoperative variables were analyzed. RESULTS: Overall, 186 patients were 
      included-145 with PDAC and 41 with dCCA. Postoperative complication rates were 
      similar for both pathologies (61% and 66% for PDAC and dCCA, respectively). Major 
      postoperative complications (MPCs), defined as Clavien-Dindo >3, occurred in 15% 
      and 24% of PDAC and dCCA patients, respectively. Patients with MPCs received 
      lower rates of adjuvant therapy administration, irrespective of primary tumor 
      (PDAC: 21 vs. 72%, p = 0.008; dCCA: 20 vs. 58%, p = 0.065). Recurrence-free 
      survival (RFS) was worse for patients with PDAC who experienced an MPC [8 months 
      (interquartile range [IQR] 1-15) vs. 23 months (IQR 19-27), p < 0.001] or who did 
      not receive any perioperative systemic therapy [11 months (IQR 7-15) vs. 23 
      months (IQR 18-29), p = 0.038]. In patients with dCCA, 1-year RFS was worse for 
      patients who did not receive adjuvant therapy (55 vs. 77%, p = 0.038). 
      CONCLUSION: Patients who underwent pancreatoduodenectomy for either PDAC or dCCA 
      and who experienced an MPC had lower rates of adjuvant therapy and worse RFS, 
      suggesting that clinicians adopt a standard neoadjuvant systemic therapy strategy 
      in patients with PDAC. Our results propose a paradigm shift towards preoperative 
      systemic therapy in patients with dCCA.
CI  - (c) 2023. Society of Surgical Oncology.
FAU - Macfie, Rebekah
AU  - Macfie R
AUID- ORCID: 0000-0001-6624-4735
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA. rclmacfie@gmail.com.
FAU - Berger, Yael
AU  - Berger Y
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Liu, Hongdau
AU  - Liu H
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Li, Thomas
AU  - Li T
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Imtiaz, Sayed
AU  - Imtiaz S
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Ang, Celina
AU  - Ang C
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Sarpel, Umut
AU  - Sarpel U
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Hiotis, Spiros
AU  - Hiotis S
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Labow, Daniel
AU  - Labow D
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Golas, Benjamin
AU  - Golas B
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
FAU - Cohen, Noah A
AU  - Cohen NA
AD  - Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, 
      New York, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20230520
PL  - United States
TA  - Ann Surg Oncol
JT  - Annals of surgical oncology
JID - 9420840
SB  - IM
CIN - Ann Surg Oncol. 2023 Aug;30(8):5035. PMID: 37179272
MH  - Humans
MH  - *Pancreatic Neoplasms/drug therapy/surgery
MH  - Pancreaticoduodenectomy/adverse effects
MH  - *Adenocarcinoma/drug therapy/surgery
MH  - Retrospective Studies
MH  - Survival Rate
MH  - *Carcinoma, Pancreatic Ductal/drug therapy/surgery
MH  - *Cholangiocarcinoma/drug therapy/surgery
MH  - Postoperative Complications/etiology/surgery
MH  - *Bile Duct Neoplasms/drug therapy/surgery/etiology
MH  - Bile Ducts, Intrahepatic/pathology
EDAT- 2023/05/21 01:05
MHDA- 2023/07/07 06:42
CRDT- 2023/05/20 23:08
PHST- 2022/10/05 00:00 [received]
PHST- 2023/04/03 00:00 [accepted]
PHST- 2023/07/07 06:42 [medline]
PHST- 2023/05/21 01:05 [pubmed]
PHST- 2023/05/20 23:08 [entrez]
AID - 10.1245/s10434-023-13533-0 [pii]
AID - 10.1245/s10434-023-13533-0 [doi]
PST - ppublish
SO  - Ann Surg Oncol. 2023 Aug;30(8):5027-5034. doi: 10.1245/s10434-023-13533-0. Epub 
      2023 May 20.