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Impact of Neoadjuvant Chemotherapy on the Rate of Clinically-Significant Postoperative Pancreatic Fistula
Sara Saeidishahri
*, Amir Ebadinejad, Oscar Serrano
Department of Surgery, Hartford Hospital, Hartford, CT
Background: While numerous studies have identified predictive factors for postoperative pancreatic fistula (POPF), limited data exist regarding the impact of neoadjuvant chemotherapy (NAC) on clinically-significant POPF in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). This study aims to evaluate the impact of NAC and clinically significant POPF using a contemporary national cohort.
Study Design: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pancreatectomy-targeted datasets for 2022 and 2023 to identify patients with a diagnosis of PDAC. Clinically-significant POPF was defined as Grade B or C fistula according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. NAC defined as patients who received chemotherapy within 90 days prior to surgery. Univariate and multivariate logistic regression analyses were performed to assess the association between NAC and clinically significant POPF, adjusting for demographic and clinical covariates.
Results: A total of 7,260 patients with PDAC were included; 48.2% received NAC; 10.3% received neoadjuvant radiation. The majority of patients (79.7%) underwent pancreaticoduodenectomy, while 20.3% underwent subtotal pancreatectomy, with or without splenectomy. Compared to those who did not receive NAC, patients in the NAC cohort were younger (66. 6±9.4 vs 68.7±10.3, p=0.001), had a higher prevalence of hard gland texture (39.9% vs 31.3%, p<0.001) and increased rates of intraoperative vascular resection (31.2% vs 17.6%, p<0.001). The incidence of clinically significant POPF was significantly lower in the NAC group compared to the non-NAC group (7.2% vs 12.6%, p<0.001). On logistic regression analysis, NAC was independently associated with a reduced risk of clinically significant POPF (OR: 0.576, 95% CI: 0.47-0.76, p<0.001), after adjusting for age, BMI, race, preoperative radiation, pancreatic duct size and gland texture, and comorbid conditions.
Conclusions: NAC seems to be associated with a significantly lower incidence of clinically-significant POPF in patients undergoing surgery for PDAC, independent of the effect from preoperative radiation. These findings imply the potential benefits of NAC in mitigating high-risk postoperative complications.
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