EFFECTS OF NEOADJUVANT THERAPY ON THE OCCURENCE OF CLINICAL RELEVANT PANCREATIC FISTULA AFTER PANCREATICODUODENECTOMY
Konstantinos A. Zorbas*1, Vic Velanovich2, Andreas Karachristos2
1BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, NY; 2University of South Florida Morsani College of Medicine, Tampa, FL
Background: Postoperative morbidity and mortality after pancreaticoduodenectomy (Whipple Procedure) has improved significantly during the last decades. However, the rate of postoperative complications remains in disproportional high rates exceeding 50% in some studies. Clinically relevant pancreatic fistula or anastomotic leak from pancreato-jejunostomy remains the most fearful complication. An increasing number of patients receive either chemotherapy or radiotherapy in neoadjuvant setting. We aimed to determine the association between preoperative therapy and clinically relevant postoperative pancreatic fistula.
Methods: The 2014 to 2017 Pancreas Targeted ACS-NSQIP databases were merged with the
2014 and 2017 ACS-NSQIP Participant User File (PUF) databases, and both were used to carry
out this study. Our inclusion criteria were patients who underwent a Whipple procedure for malignancy by using the following CPT codes: 48150, 48152, 48153 and 48154. Our exclusion criteria were cases with missing data on the preoperative chemoradiotherapy status and patients who underwent a Whipple procedure for non-malignancies. Postoperative pancreatic fistula was defined based on the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula. Patients were categorized the following four groups: patients without preoperative chemoradiotherapy, patients with preoperative chemotherapy, patients with preoperative radiotherapy and patients with preoperative combination of chemotherapy/ radiotherapy. Multivariate logistic regression was performed to assess the relationship of preoperative treatment with the odds of patients having clinically relevant postoperative pancreatic leak, after controlling for other preoperative and intraoperative factors. The adjusting factors are shown in table.
Results: Of 12277 patients, who had undergone pancreaticoduodenectomy, 9543 (77.7%) patients had no preoperative treatment, 1644 (13.4%) patients had only preoperative chemotherapy, 96 (0.8%) patients had only radiotherapy and 994 (8.1%) patients had both preoperative chemotherapy and radiotherapy. Baseline characteristics were assessed. We found a statistically significant difference between the four groups with lower rates of pancreatic fistula in all three groups of patients who received preoperative treatment compared to those patients who did not receive any type of treatment (Chart). All types of preoperative treatment reduce the risk of developing a clinically relevant postoperative pancreatic fistula, even after the adjustment for multiple possible confounding factors with multivariate analysis (Table).
Conclusions: Patients who received any type of preoperative treatment (Chemotherapy or Radiotherapy or Both) had lower chances of postoperative complications with clinically relevant postoperative pancreatic fistula.
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