Back to Annual Meeting Posters

Background: Postoperative morbidity is associated with poor long-term outcomes for gastrointestinal cancers. The purpose of this study is to determine the extent to which postoperative complications after pancreatoduodenectomy for pancreatic adenocarcinoma impact adjuvant therapy and overall survival. Methods: Over a five year period ending December 2009, 310 consecutive pancreatoduodenectomies for adenocarcinoma were performed at a single institution. Retrospective review of a prospective patient database including data on patient, operative, and tumor factors along with postoperative Clavien-Dindo (CD) classified complications, receipt of adjuvant therapy, and survival was performed. Associations with overall survival (OS), estimated by the Kaplan-Meier method, were analyzed with log-rank testing. Results: Patients were predominantly male (57%) and Caucasian (96%) with a median age at operation of 66 years (36-96 years). Median operative time was 325 minutes and median blood loss was 675mL. Sixty-three percent of patients had lymph node metastasis on final pathology. Thirty-day mortality rate was 3.2%. Major postoperative morbidity, defined as CD III-IV complications, were recorded for 40 (13%) patients, while minor complications (CD I-II) occurred in 155 (50%) of patients. Overall, 64% of patients received adjuvant chemotherapy or chemoradiotherapy, of which 5% received neoadjuvant chemoradiotherapy. Adjuvant therapy was administered to 76% of patients with no postoperative morbidity versus 63% and 42% of patients with minor or major complications, respectively (p=0.02). Median OS for the cohort was 18.3 months (0-116 months). Improved median overall and 5-year survival (20 months and 21%, respectively) for patients with no postoperative morbidity was not significantly different to the survival observed for patients with complications (18.8 months and 18% respectively), p=0.36 (Figure 1). Median OS and 5-year survival for patients who received adjuvant therapy was 21 months and 18%, respectively, versus 15.5 months and 17% for patient who did not receive adjuvant therapy, p=0.27 (Figure 2). Conclusions: Major complications after pancreatoduodenectomy alter plans for adjuvant therapy for pancreatic adenocarcinoma. Unlike other gastrointestinal cancers, postoperative morbidity is not associated with poor long-term outcomes for pancreatic adenocarcinoma.