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Impact of Neoadjuvant Systemic Therapy on Pancreatic Fistula Rates Following Pancreatectomy: a Population-Based Propensity-Matched Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Postoperative pancreatic fistula (POPF) drives morbidity and mortality following pancreatectomy. Use of neoadjuvant chemotherapy (NAC) has recently increased in the treatment of potentially resectable pancreatic ductal adenocarcinoma (PDAC). This study examined the effect of NAC on POPF rates and postoperative outcomes in PDAC.

Methods

The American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) Targeted Pancreatectomy dataset was queried to identify PDAC patients who underwent curative-intent pancreatectomies. Propensity score matching was used to stratify patients by receipt of NAC. Postoperative outcomes were compared and logistic regression applied to identify POPF predictors.

Results

Six thousand eight hundred sixty-three patients met the inclusion criteria; of those, 1908 (27.8%) received NAC and 4955 (72.2%) did not (NNAC). Two thousand sixty-two patients were matched 1:1 from each group. NAC patients had significantly lower POPF rates (9.0% vs. 14.5%; P < 0.001); the majority were categorized as grade A (5.1% vs. 9.5%). Overall 30-day morbidity was lower with NAC (40.4% vs. 49.5%; P < 0.001). Specifically, pneumonia (2.3% vs. 4.1%), organ space infections (7.9% vs. 13.2%), sepsis (5.2% vs. 8.0%), and delayed gastric emptying (10.1% vs. 14.8%) occurred less frequently in the NAC group. Postoperative mortality and unplanned reoperations were similar. On multivariate analysis, receipt of NAC was an independent predictor of decreased POPF rates (HR, 0.73 [0.56–0.94]; P = 0.016). Other factors included gland texture, duct size, male gender, and lower BMI.

Conclusions

In this propensity-matched, population-based cohort study of PDAC patients, NAC was associated with lower POPF rates and overall major complications. Those findings suggest a modest protective effect of NAC from POPF.

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Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Edward-Elmhurst Health, 120 Spalding Drive, Ste 205, Naperville, IL, 60540, USA

    Fadi S. Dahdaleh & George I. Salti

  2. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Samer A. Naffouje & George I. Salti

  3. Department of Surgical Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA

    Samer A. Naffouje

  4. Department of Colon and Rectal Surgery, Surgical Oncology, City of Hope Medical Foundation, Upland, CA, USA

    Mark H. Hanna

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  1. Fadi S. Dahdaleh
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Contributions

Study conception and design: FD, SN

Acquisition of data: SN

Analysis and interpretation of data: FD, SN, GS

Drafting of manuscript: FD, GS, SN, MH

Critical revision: GS, FD, SN

Corresponding author

Correspondence to Fadi S. Dahdaleh.

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Dahdaleh, F.S., Naffouje, S.A., Hanna, M.H. et al. Impact of Neoadjuvant Systemic Therapy on Pancreatic Fistula Rates Following Pancreatectomy: a Population-Based Propensity-Matched Analysis. J Gastrointest Surg 25, 747–756 (2021). https://doi.org/10.1007/s11605-020-04581-y

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  • DOI: https://doi.org/10.1007/s11605-020-04581-y

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