Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

BACKGROUND: Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States. In patients with “borderline resectable” disease, current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticod...

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Detalles Bibliográficos
Autores principales: Aploks, Krist, Kim, Minha, Stroever, Stephanie, Ostapenko, Alexander, Sim, Young Bo, Sooriyakumar, Ashwinkumar, Rahimi-Ardabily, Arash, Seshadri, Ramanathan, Dong, Xiang Da
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Retrospective Study
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494586/
https://www.ncbi.nlm.nih.gov/pubmed/37701691
http://dx.doi.org/10.4240/wjgs.v15.i8.1663
Descripción
Sumario:BACKGROUND: Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States. In patients with “borderline resectable” disease, current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy. Although neoadjuvant radiotherapy may improve negative margin resection rate, it is theorized that its administration increases operative times and complexity. AIM: To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma. METHODS: Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set, who received a pancreaticoduodenectomy for pancreatic adenocarcinoma, were divided into two groups based off neoadjuvant radiotherapy status. Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy, perioperative blood transfusion status, total operative time, and other perioperative outcomes. RESULTS: Of the 11458 patients included in the study, 1470 (12.8%) underwent neoadjuvant radiotherapy. Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion [adjusted odds ratio (aOR) = 1.58, 95% confidence interval (CI): 1.37-1.82; P < 0.001] and have longer surgeries (insulin receptor-related receptor = 1.14, 95%CI: 1.11-1.16; P < 0.001), while simultaneously having lower rates of organ space infections (aOR = 0.80, 95%CI: 0.66-0.97; P = 0.02) and pancreatic fistula formation (aOR = 0.50, 95%CI: 0.40-0.63; P < 0.001) compared to those who underwent surgery alone. CONCLUSION: Neoadjuvant radiotherapy, while not associated with increased mortality, will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.

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