M. Shah1, A. Khalid2, N. Amini2, M. Weiss1,2,3 1Northwell, New Hyde Park, NY, USA 2Northwell, Department Of Surgery, New Hyde Park, NY, USA 3Northwell, Cancer Institute, New Hyde Park, NY, USA
Introduction: Neoadjuvant chemotherapy (NACT) is being increasingly used in pancreatic cancer, as it may increase the rate of margin-negative resections for resectable tumors and improve resection rates for unresectable tumors. We sought to investigate the effect of NACT on postoperative pancreas-related complications, which is currently ill-defined.
Methods: We queried the American College of Surgeons NSQIP Targeted Pancreatectomy Participant Use Files from 2019-2021 to identify patients with resectable pancreatic cancer receiving NACT. Multivariable regression analysis was performed to determine association of NACT to pancreas-related complications, namely postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and placement of a drain.
Results: 76,644 patients had data regarding NACT treatment from 2019-2021, of which 15,118 (19.7%) received NACT and 61,526 (80.3%) did not receive NACT. On multivariable analysis, patients who did not receive NACT were more likely to develop POPF (OR: 2.063, 95% CI: 1.956-2.176, p<0.001), develop DGE (OR: 1.134, 95% CI: 1.073-1.198, p<0.001), and receive a percutaneous drain (OR: 1.456, 95% CI: 1.372-1.545, p<0.001). The 2021 pancreatectomy data provided the specific type of surgery for 702 patients, of which 536 (76.4%) had a Whipple, 147 (20.9%) had a distal pancreatectomy, and 19 (2.7%) received a total pancreatectomy. Whipple patients who did not receive NACT were more likely to develop a complication compared to those receiving NACT (38.0% vs. 18.6%, p<0.0001) (Figure).
Conclusion: Treatment approaches incorporating NACT can be considered safe with respect to these pancreas-related complications. Administration of chemotherapy prior to a Whipple is associated with a lower likelihood of developing these complications.