T. Tan1, C. McDaniel1, W. W. Zhang1, D. Rybin2, G. Doros2, Q. Chu1 1Louisiana State University Health Sciences Center,Depatment Of Surgery,Shreveport, LA, USA 2Boston Medical Center,Boston, MA, USA
Introduction: We evaluated the outcomes of patients undergoing pancreaticoduodenectomy who received neoadjuvant radiation therapy and chemotherapy for pancreatic cancer.
Methods: Using the National Surgical Quality Improvement Program dataset (2005-2012), we identified and examined 10,217 pancreaticoduodenectomy using the ICD-9 and CPT codes. Patients were divided into two groups based on whether they received neoadjuvant radiation and chemotherapy. Outcomes evaluated were perioperative mortality and morbidity. Multivariable logistic regression was used to examine association between neoadjuvant therapy and perioperative outcomes adjusting for possible confounders.
Results: There were 10,217 pancreaticoduodenectomys in this study cohort with 488 patients (5%) receiving neoadjuvant therapy prior to surgery. Patients who were treated with neoadjuvant therapy had significant higher history of >10% weight lost prior to surgery (26% vs. 18%, p<.001), chronic steroid therapy (3% vs. 2%, p=.03), and significantly longer operative time (443±140 vs. 373±128 minutes, p<.001). Although perioperative survival was similar between two cohorts, those treated with neoadjuvant therapy had significantly higher risk of surgical site infection (SSI) (14% vs. 10%, p=.002), thromboembolism (5% vs. 3%, p=.03) but lower risk of pneumonia (3% vs. 5%, p=.10). In multivariable analysis, neoadjuvant therapy was associated with increased risk of SSI (OR 1.4, 95% CI 1, 1.8, p=.02), but lower risk of pneumonia (OR 0.5, 95% CI 0.3, 0.8, p=.007).
Conclusion: Patients who received neoadjuvant radiation therapy and chemotherapy have significant higher risk of surgical site infection following pancreaticoduodenectomy for pancreatic cancer. Further studies are required to evaluate appropriate role of neoadjuvant therapy in patients undergoing surgical treatment for pancreatic cancer.