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Background: Postoperative complications significantly affect disease-specific survival (DSS) after surgery for different tumors. The aim of the study is to assess the impact on survival of postoperative course after surgery for pancreatic ductal adenocarcinoma (PDAC).
Methods: Retrospective analysis of 431 patients who underwent pancreatic resections with curative intent (R0-R1) for PDAC between 2000 and 2009.
Results: Surgical procedures included pancreaticoduodenectomy (n=347, 80.5%), distal pancreatectomy (n=68, 16%) and total pancreatectomy (n=16, 3.5%). Overall morbidity was 37%. In-hospital or 30-day mortality rate was 1.6%. Overall, 132 patients (31%) had abdominal complications, including 72 (17%) patients with pancreatic fistula and 46 (10.5%) with abdominal collections/abscesses. The median length of stay (LOS) was 10 days (IQR 8;15). Patients with abdominal complications had a significantly higher LOS (15 vs 9.5 days, P<0.0001). The median DSS for the entire cohort was 28.4 months (CI 95% 24.5-32.3). Patients with abdominal complications had a median DSS of 25 months (CI 95% 19.5-30.8) compared to 30.5 months (CI 95% 25.7-35.2) for those without complications (P=0.144). Adjuvant treatment was administered in 70.5% of patients with abdominal complications and in the 82% of those with an uneventful postoperative course (P=0.010). On multivariable analysis factors independently associated with survival were: the presence of abdominal complications (HR 1.40; P=0.009), adjuvant treatment (HR 0.628; P=0.001), N1 status (HR 1.93; P<0.0001), R1 resection (HR 1.87; P<0.0001), G3 vs G1 (HR 4.33; P<0.0001) and G2 vs G1 (HR 2.99; P=0.005).
Conclusions: Postoperative abdominal complications are independent predictors of survival after resection for PDAC. The mechanism behind this association may be related to an immunologic impairment due to surgical complications and to a lower rate of adjuvant therapy administration in this subgroup.