IMPACT OF POSTOPERATIVE PANCREATIC FISTULA ON THE PROGNOSIS OF PATIENTS UNDERGOING RESECTION FOR PANCREATIC DUCTAL ADENOCARCINOMA
Motokazu Sugimoto*, Shin Kobayashi, Shinichiro Takahashi, Masaru Konishi, Naoto Gotohda
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
Background Postoperative pancreatic fistula (POPF) is a major morbidity that can occur after pancreatectomy. However, the impact of POPF on survival outcomes remains unclear. This study aimed to investigate the relationship between perioperative clinicopathological factors and survival outcomes in patients with pancreatic ductal adenocarcinoma (PDAC).
Methods The study included 366 patients who underwent pancreatectomy for PDAC between January 2007 and December 2016. POPF was defined as grade B or C of the International Study Group of Pancreatic Surgery criteria in 2016. Perioperative clinicopathological data were evaluated for their association with the risk of a shorter disease-specific survival (DSS) and recurrence-free survival (RFS).
Results Of the 366 patients, the median age was 68, and 232 patients (63%) were male. There were 253 patients undergoing pancreaticoduodenectomy (PD) and 113 patients undergoing distal pancreatectomy (DP). Among 253 PD patients, 33 (13%) developed POPF, while among 113 DP patients, 45 (40%) developed POPF. The median duration of follow-up was 38 months. Independent risk factors for a shorter DSS were lower serum albumin level (hazard ratio (HR) 1.558, P = 0.015), greater intraoperative blood loss (HR 1.000, P = 0.025), larger tumor size (HR 1.019, P = 0.009), lymph node metastasis (HR 1.797, P = 0.005), and a lack of adjuvant chemotherapy (HR 2.110, P < 0.015). Independent risk factors for a shorter RFS were lower serum albumin level (HR 1.450, P = 0.020), greater intraoperative blood loss (HR 1.000, P = 0.006), larger tumor size (HR 1.017, P = 0.002), lymph node metastasis (HR 1.904, P < 0.001), and a lack of adjuvant chemotherapy (HR 2.128, P < 0.001). POPF was not associated with DFS (HR 1.077, P = 0.696) or RFS (HR 1.115, P = 0.479). However, compared with patients without POPF, those with POPF received adjuvant chemotherapy less frequently (68% vs. 79%, P = 0.037) and had a longer duration to start adjuvant chemotherapy after surgery (61 days vs. 52 days, P = 0.001).
Conclusions There were no relationship between the occurrence of POPF and survival outcomes in patients who underwent surgery for PDAC. However, because patients with POPF had a smaller chance to receive adjuvant chemotherapy and a longer time to be withheld from adjuvant chemotherapy, POPF might affect on their survival outcomes. Prevention of POPF appears to be important to improve survival outcomes for patients with PDAC.
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