Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer

Anh Thu Le, Bin Huang, Dima Hnoosh, Hayder Saeed, Sean P. Dineen, Peter Hosein, Eric B. Durbin, Mahesh Kudrimoti, Patrick C. McGrath, Ching Wei D. Tzeng

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Although adjuvant therapy (AT) is a necessary component of multimodality therapy for pancreatic ductal adenocarcinoma (PDAC), its application can be hindered by post-pancreaticoduodenectomy (PD) complications. The primary aim of this study was to evaluate the impact of post-PD complications on AT utilization and overall survival (OS). Methods Patients undergoing PD without neoadjuvant therapy for stages I-III PDAC at a single institution (2007-2015) were evaluated. Ninety-day postoperative major complications (PMCs) were defined as grade ≥3. Records were linked to the Kentucky Cancer Registry for AT/OS data. Early AT was given <8 wk; late 8-16 wk. Initiation >16 wk was not considered to be AT. Complication effects on AT timing/utilization and OS were evaluated. Results Of 93 consecutive patients treated with surgery upfront with AT data, 64 (69%) received AT (41 [44%] early; 23 [25%] late). There were 32 patients (34%) with low-grade complications and 24 (26%) with PMC. With PMC, only six of 24 patients (25%) received early AT and 13 of 24 (54%) received any (early/late) AT versus 35 of 69 (51%) early AT and 51 of 69 (74%) any AT without PMC. PMCs were associated with worse median OS (7.1 versus 24.6 mo, without PMC, P < 0.001). Independent predictors of OS included AT (hazard ratio [HR]: 0.48), tumor >2 cm (HR: 3.39), node-positivity (HR: 2.16), and PMC (HR: 3.69, all P < 0.02). Conclusions Independent of AT utilization and biologic factors, PMC negatively impacted OS in patients treated with surgery first. These data suggest that strategies to decrease PMC and treatment sequencing alternatives to increase multimodality therapy rates may improve oncologic outcomes for PDAC.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Surgical Research
Volume214
DOIs
StatePublished - Jun 15 2017

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Pancreaticoduodenectomy
Pancreatic Neoplasms
Therapeutics
Secondary Prevention
Survival
Adenocarcinoma
Neoadjuvant Therapy
Biological Factors
Registries

Keywords

  • Adjuvant therapy
  • Complications
  • Pancreatic cancer
  • Pancreaticoduodenectomy
  • Resection
  • Survival
  • Whipple

ASJC Scopus subject areas

  • Surgery

Cite this

Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer. / Le, Anh Thu; Huang, Bin; Hnoosh, Dima; Saeed, Hayder; Dineen, Sean P.; Hosein, Peter; Durbin, Eric B.; Kudrimoti, Mahesh; McGrath, Patrick C.; Tzeng, Ching Wei D.

In: Journal of Surgical Research, Vol. 214, 15.06.2017, p. 1-8.

Research output: Contribution to journalArticle

Le, AT, Huang, B, Hnoosh, D, Saeed, H, Dineen, SP, Hosein, P, Durbin, EB, Kudrimoti, M, McGrath, PC & Tzeng, CWD 2017, 'Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer', Journal of Surgical Research, vol. 214, pp. 1-8. https://doi.org/10.1016/j.jss.2017.02.036
Le, Anh Thu ; Huang, Bin ; Hnoosh, Dima ; Saeed, Hayder ; Dineen, Sean P. ; Hosein, Peter ; Durbin, Eric B. ; Kudrimoti, Mahesh ; McGrath, Patrick C. ; Tzeng, Ching Wei D. / Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer. In: Journal of Surgical Research. 2017 ; Vol. 214. pp. 1-8.
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abstract = "Background Although adjuvant therapy (AT) is a necessary component of multimodality therapy for pancreatic ductal adenocarcinoma (PDAC), its application can be hindered by post-pancreaticoduodenectomy (PD) complications. The primary aim of this study was to evaluate the impact of post-PD complications on AT utilization and overall survival (OS). Methods Patients undergoing PD without neoadjuvant therapy for stages I-III PDAC at a single institution (2007-2015) were evaluated. Ninety-day postoperative major complications (PMCs) were defined as grade ≥3. Records were linked to the Kentucky Cancer Registry for AT/OS data. Early AT was given <8 wk; late 8-16 wk. Initiation >16 wk was not considered to be AT. Complication effects on AT timing/utilization and OS were evaluated. Results Of 93 consecutive patients treated with surgery upfront with AT data, 64 (69{\%}) received AT (41 [44{\%}] early; 23 [25{\%}] late). There were 32 patients (34{\%}) with low-grade complications and 24 (26{\%}) with PMC. With PMC, only six of 24 patients (25{\%}) received early AT and 13 of 24 (54{\%}) received any (early/late) AT versus 35 of 69 (51{\%}) early AT and 51 of 69 (74{\%}) any AT without PMC. PMCs were associated with worse median OS (7.1 versus 24.6 mo, without PMC, P < 0.001). Independent predictors of OS included AT (hazard ratio [HR]: 0.48), tumor >2 cm (HR: 3.39), node-positivity (HR: 2.16), and PMC (HR: 3.69, all P < 0.02). Conclusions Independent of AT utilization and biologic factors, PMC negatively impacted OS in patients treated with surgery first. These data suggest that strategies to decrease PMC and treatment sequencing alternatives to increase multimodality therapy rates may improve oncologic outcomes for PDAC.",
keywords = "Adjuvant therapy, Complications, Pancreatic cancer, Pancreaticoduodenectomy, Resection, Survival, Whipple",
author = "Le, {Anh Thu} and Bin Huang and Dima Hnoosh and Hayder Saeed and Dineen, {Sean P.} and Peter Hosein and Durbin, {Eric B.} and Mahesh Kudrimoti and McGrath, {Patrick C.} and Tzeng, {Ching Wei D.}",
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T1 - Effect of complications on oncologic outcomes after pancreaticoduodenectomy for pancreatic cancer

AU - Le, Anh Thu

AU - Huang, Bin

AU - Hnoosh, Dima

AU - Saeed, Hayder

AU - Dineen, Sean P.

AU - Hosein, Peter

AU - Durbin, Eric B.

AU - Kudrimoti, Mahesh

AU - McGrath, Patrick C.

AU - Tzeng, Ching Wei D.

PY - 2017/6/15

Y1 - 2017/6/15

N2 - Background Although adjuvant therapy (AT) is a necessary component of multimodality therapy for pancreatic ductal adenocarcinoma (PDAC), its application can be hindered by post-pancreaticoduodenectomy (PD) complications. The primary aim of this study was to evaluate the impact of post-PD complications on AT utilization and overall survival (OS). Methods Patients undergoing PD without neoadjuvant therapy for stages I-III PDAC at a single institution (2007-2015) were evaluated. Ninety-day postoperative major complications (PMCs) were defined as grade ≥3. Records were linked to the Kentucky Cancer Registry for AT/OS data. Early AT was given <8 wk; late 8-16 wk. Initiation >16 wk was not considered to be AT. Complication effects on AT timing/utilization and OS were evaluated. Results Of 93 consecutive patients treated with surgery upfront with AT data, 64 (69%) received AT (41 [44%] early; 23 [25%] late). There were 32 patients (34%) with low-grade complications and 24 (26%) with PMC. With PMC, only six of 24 patients (25%) received early AT and 13 of 24 (54%) received any (early/late) AT versus 35 of 69 (51%) early AT and 51 of 69 (74%) any AT without PMC. PMCs were associated with worse median OS (7.1 versus 24.6 mo, without PMC, P < 0.001). Independent predictors of OS included AT (hazard ratio [HR]: 0.48), tumor >2 cm (HR: 3.39), node-positivity (HR: 2.16), and PMC (HR: 3.69, all P < 0.02). Conclusions Independent of AT utilization and biologic factors, PMC negatively impacted OS in patients treated with surgery first. These data suggest that strategies to decrease PMC and treatment sequencing alternatives to increase multimodality therapy rates may improve oncologic outcomes for PDAC.

AB - Background Although adjuvant therapy (AT) is a necessary component of multimodality therapy for pancreatic ductal adenocarcinoma (PDAC), its application can be hindered by post-pancreaticoduodenectomy (PD) complications. The primary aim of this study was to evaluate the impact of post-PD complications on AT utilization and overall survival (OS). Methods Patients undergoing PD without neoadjuvant therapy for stages I-III PDAC at a single institution (2007-2015) were evaluated. Ninety-day postoperative major complications (PMCs) were defined as grade ≥3. Records were linked to the Kentucky Cancer Registry for AT/OS data. Early AT was given <8 wk; late 8-16 wk. Initiation >16 wk was not considered to be AT. Complication effects on AT timing/utilization and OS were evaluated. Results Of 93 consecutive patients treated with surgery upfront with AT data, 64 (69%) received AT (41 [44%] early; 23 [25%] late). There were 32 patients (34%) with low-grade complications and 24 (26%) with PMC. With PMC, only six of 24 patients (25%) received early AT and 13 of 24 (54%) received any (early/late) AT versus 35 of 69 (51%) early AT and 51 of 69 (74%) any AT without PMC. PMCs were associated with worse median OS (7.1 versus 24.6 mo, without PMC, P < 0.001). Independent predictors of OS included AT (hazard ratio [HR]: 0.48), tumor >2 cm (HR: 3.39), node-positivity (HR: 2.16), and PMC (HR: 3.69, all P < 0.02). Conclusions Independent of AT utilization and biologic factors, PMC negatively impacted OS in patients treated with surgery first. These data suggest that strategies to decrease PMC and treatment sequencing alternatives to increase multimodality therapy rates may improve oncologic outcomes for PDAC.

KW - Adjuvant therapy

KW - Complications

KW - Pancreatic cancer

KW - Pancreaticoduodenectomy

KW - Resection

KW - Survival

KW - Whipple

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