New England Surgical Society

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Impact of Modern Neoadjuvant Chemotherapy on Perioperative Outcomes in Patients Undergoing Pancreaticoduodenectomy for Adenocarcinoma.
*Sara Abou Azar, *Whitney S. Brandt, Raymond A. Jean, John W. Kunstman, Ronald R. Salem
Yale University School of Medicine, New Haven, CT

Objective: Modern day neoadjuvant chemotherapy (NAC) is being utilized increasingly in pancreatic ductal adenocarcinoma (PDAC) to improve resectability and treat micrometastases. Perioperative outcomes of these patients when undergoing pancreaticoduodenectomy (PD) is unclear. This study compared operative outcomes of PD with or without NAC.
Design: Retrospective matched cohort
Setting: Academic center
Patients: Patients with PDAC undergoing PD with curative intent receiving ≥2 cycles of NAC were matched 1:1 with ‘Surgery First’ patients by serious complication risk per the ACS-NSQIP Surgical Risk Calculator (riskcalculator.facs.org) and pancreatic fistula (PF) risk as determined by Fistula Risk Score.
Interventions: Receipt of NAC
Main Outcome Measure: The primary outcome measures were 90-day serious (grade≥3) surgical complications and clinically-relevant PF (CR-PF); secondary measures included impact of age, operative blood loss, length of stay (LOS), and related outcomes.
Results: 126 patients were analyzed; 63 received NAC (median doses 6 [range, 2-51]). 56 (88.9%) received FOLFIRINOX. No difference in major complications (N=9 [14.3%] versus 10 [15.9%], p=1.0) or CR-PF (N=1 [1.6%] versus 3 [4.8%], p=0.63) were observed between the NAC and Surgery First cohorts. Blood loss was higher in those receiving NAC (509±585 versus 316±199 mL; p<0.01). Index LOS was unchanged between NAC and Surgery First groups (6.0±3.6 versus 5.7±2.9 days; p=0.69) but surgery first patients had a trend towards more frequent readmission (N=17 [27.0%] versus 8 [12.7%], p=0.06). Similar outcomes were observed in patients ≥75 years (NAC, N=13 [20.6%]; Surgery First, N=16 [25.4%]).
Conclusions: Patients, including those ≥75 years, receiving NAC prior to PD experience higher operative blood loss but no detriment to perioperative morbidity or outcomes when compared to a matched cohort of patients managed via a surgery-first approach.


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