A. A. Mokdad1, C. A. Hester1, S. C. Wang1, M. R. Porembka1, M. M. Augustine1, A. C. Yopp1, J. C. Mansour1, R. M. Minter1, M. A. Choti1, P. M. Polanco1 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA
Introduction: Preoperative therapy is being increasingly used in the management of resectable and borderline resectable pancreatic cancer. Some data suggest that long-term outcomes are comparable between preoperative chemotherapy and preoperative chemoradiation; however, chemoradiation may be associated with worse early postoperative outcomes. In this study, we compared early postoperative morbidity and mortality between preoperative chemotherapy and chemoradiation in resected pancreatic adenocarcinoma.
Methods: We used the National Surgical Quality Improvement Program (NSQIP) complemented by the NSQIP procedure targeted pancreatectomy variables for 2014 and 2015. We included patients with non-metastatic adenocarcinoma of the pancreas who received preoperative chemotherapy (preopCT) or chemoradiation (preopCRT) followed by resection. Patients undergoing enucleation or emergent resection were excluded. We abstracted patient demographic and comorbidity data as well as perioperative information. We compared early postoperative outcomes between the preopCT and preopCRT groups. We used inverse probability of treatment weighting (IPTW)–estimated using a propensity score–to adjust for preoperative and intraoperative variables.
Results: A total of 1,133 patients were included; 609 (54%) in the preopCT group and 524 (46%) in the preopCRT group. Most patients underwent a pancreaticoduodenectomy (77%). Preoperative stent placement was comparable between preopCT and preopCRT (54% vs 55%, P=0.86) and 34% vs 39% (P=0.07) had a vascular resection, respectively. PreopCT was associated with higher pathological stages (stages 2 or 3: 89% vs 78%, P<0.01) and firmer pancreatic tissue (58% vs 69%, P<0.01). After adjusting using IPTW, organ space surgical site infections (8% vs 8%, adjusted P (aP)=0.79), pancreatic fistula (10% vs 11%, aP=0.42), delayed gastric emptying (13% vs 13%, aP=0.66), intraoperative and immediate postoperative blood transfusions (27% vs 27%, aP=0.71), reoperation within 30 days (6% vs 6%, aP=1.00), length of stay (9.5 days vs 9.5 days, aP=0.88), discharge to home (88% vs 87%, aP=0.12), and 30-day mortality (2% vs 1%, aP=0.78) were comparable between preopCT and preopCRT. Mean operative time was longer in preopCRT (376 minutes vs 415 minutes, aP<0.01) and unplanned 30-day readmissions were more common in preopCRT (14% vs 21%, aP<0.01).
Conclusion: Early postoperative morbidity and mortality after pancreatic resection are largely comparable between preoperative chemotherapy and preoperative chemoradiation. Our findings support equipoise between preoperative chemotherapy and chemoradiation and highlight the need to evaluate further the role of these regimens in ongoing and future preoperative clinical trials for pancreatic adenocarcinoma.