K. A. Mirkin1, C. Hollenbeak1, N. Gusani1, J. Wong1 1Penn State Hershey Medical Center,General Surgery,Hershey, PA, USA
Introduction:
Pancreatic cancer is the fourth leading cause of cancer death in the US with surgical resection and chemotherapy offering the only chance of long-term survival. Neoadjuvant therapy (NAT) is utilized in certain patients to optimize outcomes. The objective of this study was to analyze trends in NAT utilization and compare short-term outcomes in patients receiving NAT and surgery to patients undergoing initial surgical management for clinical stage I – III pancreatic cancer.
Methods:
This was a retrospective analysis of the National Cancer Data Base (2003-2011), evaluating trends in utilization and short-term outcomes (30- and 90-day mortality and hospital length of stay) in pancreatic cancer patients. Patients with clinical stages I-III adenocarcinoma and carcinoma of the pancreas who underwent surgery, both with and without NAT (chemotherapy, radiation, or both), were included. Univariate statistics were used to compare characteristics of patients who underwent initial surgery versus NAT followed by surgery. Logistic and linear regression models were used to model 30- and 90-day mortality and length of stay, respectively.
Results:
The analysis included 6,204 patients who underwent initial surgery and 10,245 patients who received NAT and surgery. Patients undergoing initial surgery tended to be older, female, covered by Medicare, and had lower staged disease. Over the past decade, initial surgical management and multimodality NAT has steadily decreased. Use of neoadjuvant radiation has remained relatively static with low rates of utility. Use of neoadjuvant chemotherapy, however, has been rising steadily. Mortality rates at 30 and 90 days were significantly higher for patients undergoing initial surgery compared to patients receiving NAT and surgery (9.3% vs. 0.5%, p<0.0001, 17.8% vs. 2.0%, p<0.0001, respectively). After controlling for patient, disease and surgery characteristics, patients who received NAT had a 94% lower odds of mortality at 30 days (p < 0.0001) and an 90% lower odds at 90 days (P<0.0001). Length of stay was significantly higher for patients undergoing initial surgery as compared to patients receiving NAT and surgery (13.4 days vs. 10.1 days, p<0.0001). More advanced clinical stage disease, pancreatoduodenectomy or total pancreatectomy also negatively impacted 30 and 90 day mortality as well as hospital length of stay.
Conclusion:
The utilization of neoadjuvant chemotherapy has been increasing steadily for the past decade, while initial surgical resection has been decreasing. Use of multimodality NAT also appears to be decreasing. Neoadjuvant therapy does not appear to have any adverse effect on short-term outcomes, including 30- and 90-day mortality and hospital length of stay.
