Impact of Neoadjuvant Treatment and Minimally Invasive Surgery on Perioperative Outcomes of Pancreatoduodenectomy: an ACS NSQIP Analysis.
Neoadjuvant therapy
Operative approach
Pancreatoduodenectomy
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
30 Oct 2023
30 Oct 2023
Historique:
received:
24
04
2023
accepted:
31
08
2023
medline:
31
10
2023
pubmed:
31
10
2023
entrez:
31
10
2023
Statut:
aheadofprint
Résumé
There is an increasing use of neoadjuvant treatment (NAT) for pancreatic cancer (PC) followed by minimally invasive pancreatoduodenectomy (MIPD). We evaluate the impact of the surgical approach on 30-day outcomes in PC patients who underwent NAT. Patients with PC who had NAT followed by MIPD or open pancreatoduodenectomy (OPD) were identified from a pancreatectomy-targeted dataset (2014-2020) of the National Surgical Quality Improvement Program. Comparisons were made between MIPD and OPD within NAT groups. A total of 5588 patients were analyzed. Of those, 4907 underwent OPD and 476 underwent MIPD. In addition, 3559 patients received neoadjuvant chemotherapy alone and 1830 received neoadjuvant chemoradiation. In the chemotherapy-alone group, the MIPD subgroup had lower rates of any complication (38.2% vs. 45.8%, P = 0.005), but there were no differences in mortality (2.1% for MIPD vs 1.9% for OPD, P=0.8) or serious complication (11.8% for MIPD vs 15% for OPD, P=0.1). On multivariable analysis, MIPD was independently predictive of lower rates of any complication (OR: 0.74, 95% CI 0.6-0.93, P = 0.0009), CR-POPF (OR: 0.58, 95% CI 0.35-0.96, P = 0.04), and shorter LOS (estimate: -1.03, 95% CI -1.73 to -0.32, P = 0.004). In the chemoradiation group, patients undergoing MIPD had higher rates of preoperative diabetes (P < 0.05), but there were no significant differences in any outcomes between the two approaches in this group. MIPD is safe and feasible after NAT. Patients having neoadjuvant chemotherapy alone followed by MIPD had lower rates of complications, shorter LOS, and fewer CR-POPFs compared to OPD.
Sections du résumé
BACKGROUND
BACKGROUND
There is an increasing use of neoadjuvant treatment (NAT) for pancreatic cancer (PC) followed by minimally invasive pancreatoduodenectomy (MIPD). We evaluate the impact of the surgical approach on 30-day outcomes in PC patients who underwent NAT.
METHODS
METHODS
Patients with PC who had NAT followed by MIPD or open pancreatoduodenectomy (OPD) were identified from a pancreatectomy-targeted dataset (2014-2020) of the National Surgical Quality Improvement Program. Comparisons were made between MIPD and OPD within NAT groups.
RESULTS
RESULTS
A total of 5588 patients were analyzed. Of those, 4907 underwent OPD and 476 underwent MIPD. In addition, 3559 patients received neoadjuvant chemotherapy alone and 1830 received neoadjuvant chemoradiation. In the chemotherapy-alone group, the MIPD subgroup had lower rates of any complication (38.2% vs. 45.8%, P = 0.005), but there were no differences in mortality (2.1% for MIPD vs 1.9% for OPD, P=0.8) or serious complication (11.8% for MIPD vs 15% for OPD, P=0.1). On multivariable analysis, MIPD was independently predictive of lower rates of any complication (OR: 0.74, 95% CI 0.6-0.93, P = 0.0009), CR-POPF (OR: 0.58, 95% CI 0.35-0.96, P = 0.04), and shorter LOS (estimate: -1.03, 95% CI -1.73 to -0.32, P = 0.004). In the chemoradiation group, patients undergoing MIPD had higher rates of preoperative diabetes (P < 0.05), but there were no significant differences in any outcomes between the two approaches in this group.
CONCLUSION
CONCLUSIONS
MIPD is safe and feasible after NAT. Patients having neoadjuvant chemotherapy alone followed by MIPD had lower rates of complications, shorter LOS, and fewer CR-POPFs compared to OPD.
Identifiants
pubmed: 37903972
doi: 10.1007/s11605-023-05859-7
pii: 10.1007/s11605-023-05859-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Society for Surgery of the Alimentary Tract.
Références
Kuhlmann KF, de Castro SM, Wesseling JG, ten Kate FJ, Offerhaus GJ, Busch OR, et al. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer. 2004;40(4):549-58.
doi: 10.1016/j.ejca.2003.10.026
pubmed: 14962722
Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817-25.
doi: 10.1056/NEJMoa1011923
pubmed: 21561347
Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308(2):147-56.
doi: 10.1001/jama.2012.7352
pubmed: 22782416
Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. Jama. 2013;310(14):1473-81.
doi: 10.1001/jama.2013.279201
pubmed: 24104372
Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369(18):1691-703.
doi: 10.1056/NEJMoa1304369
Merkow RP, Bilimoria KY, Tomlinson JS, Paruch JL, Fleming JB, Talamonti MS, et al. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg. 2014;260(2):372-7.
doi: 10.1097/SLA.0000000000000378
pubmed: 24374509
Tzeng CW, Tran Cao HS, Lee JE, Pisters PW, Varadhachary GR, Wolff RA, et al. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg. 2014;18(1):16-24; discussion -5.
Rhim AD, Mirek ET, Aiello NM, Maitra A, Bailey JM, McAllister F, et al. EMT and dissemination precede pancreatic tumor formation. Cell. 2012;148(1-2):349-61.
doi: 10.1016/j.cell.2011.11.025
pubmed: 22265420
pmcid: 3266542
Yachida S, Jones S, Bozic I, Antal T, Leary R, Fu B, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467(7319):1114-7.
doi: 10.1038/nature09515
pubmed: 20981102
pmcid: 3148940
Artinyan A, Anaya DA, McKenzie S, Ellenhorn JD, Kim J. Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma. Cancer. 2011;117(10):2044-9.
doi: 10.1002/cncr.25763
pubmed: 21523715
Cheng TY, Sheth K, White RR, Ueno T, Hung CF, Clary BM, et al. Effect of neoadjuvant chemoradiation on operative mortality and morbidity for pancreaticoduodenectomy. Ann Surg Oncol. 2006;13(1):66-74.
doi: 10.1245/ASO.2006.02.003
pubmed: 16372154
Lutfi W, Talamonti MS, Kantor O, Wang CH, Liederbach E, Stocker SJ, et al. Perioperative chemotherapy is associated with a survival advantage in early stage adenocarcinoma of the pancreatic head. Surgery. 2016;160(3):714-24.
doi: 10.1016/j.surg.2016.05.029
pubmed: 27422328
Mokdad AA, Minter RM, Zhu H, Augustine MM, Porembka MR, Wang SC, et al. Neoadjuvant Therapy Followed by Resection Versus Upfront Resection for Resectable Pancreatic Cancer: A Propensity Score Matched Analysis. J Clin Oncol. 2017;35(5):515-22.
doi: 10.1200/JCO.2016.68.5081
pubmed: 27621388
Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5):408-10.
doi: 10.1007/BF00642443
pubmed: 7915434
Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145(1):19-23.
doi: 10.1001/archsurg.2009.243
pubmed: 20083750
Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205(2):222-30.
doi: 10.1016/j.jamcollsurg.2007.04.004
pubmed: 17660068
Napoli N, Kauffmann EF, Palmeri M, Miccoli M, Costa F, Vistoli F, et al. The Learning Curve in Robotic Pancreaticoduodenectomy. Dig Surg. 2016;33(4):299-307.
doi: 10.1159/000445015
pubmed: 27215422
Nassour I, Wang SC, Porembka MR, Yopp AC, Choti MA, Augustine MM, et al. Robotic Versus Laparoscopic Pancreaticoduodenectomy: a NSQIP Analysis. J Gastrointest Surg. 2017;21(11):1784-92.
doi: 10.1007/s11605-017-3543-6
pubmed: 28819886
pmcid: 5789456
Zureikat AH, Beane JD, Zenati MS, Al Abbas AI, Boone BA, Moser AJ, et al. 500 Minimally Invasive Robotic Pancreatoduodenectomies: One Decade of Optimizing Performance. Ann Surg. 2021;273(5):966-72.
doi: 10.1097/SLA.0000000000003550
pubmed: 31851003
Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ, 3rd. 250 robotic pancreatic resections: safety and feasibility. Ann Surg. 2013;258(4):554-9; discussion 9-62.
Zureikat AH, Nguyen KT, Bartlett DL, Zeh HJ, Moser AJ. Robotic-assisted major pancreatic resection and reconstruction. Arch Surg. 2011;146(3):256-61.
doi: 10.1001/archsurg.2010.246
pubmed: 21079111
Zureikat AH, Postlewait LM, Liu Y, Gillespie TW, Weber SM, Abbott DE, et al. A Multi-institutional Comparison of Perioperative Outcomes of Robotic and Open Pancreaticoduodenectomy. Ann Surg. 2016;264(4):640-9.
doi: 10.1097/SLA.0000000000001869
pubmed: 27433907
Asbun HJ, Moekotte AL, Vissers FL, Kunzler F, Cipriani F, Alseidi A, et al. The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection. Ann Surg. 2020;271(1):1-14.
doi: 10.1097/SLA.0000000000003590
pubmed: 31567509
Peng L, Lin S, Li Y, Xiao W. Systematic review and meta-analysis of robotic versus open pancreaticoduodenectomy. Surgical Endoscopy. 2017;31(8):3085-97.
doi: 10.1007/s00464-016-5371-2
pubmed: 27928665
Nassour I, Wang SC, Christie A, Augustine MM, Porembka MR, Yopp AC, et al. Minimally Invasive Versus Open Pancreaticoduodenectomy: A Propensity-matched Study From a National Cohort of Patients. Annals of Surgery. 2018;268(1):151-7.
doi: 10.1097/SLA.0000000000002259
pubmed: 28486387
Palanivelu C, Senthilnathan P, Sabnis SC, Babu NS, Srivatsan Gurumurthy S, Anand Vijai N, et al. Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg. 2017;104(11):1443-50.
doi: 10.1002/bjs.10662
pubmed: 28895142
Poves I, Burdio F, Morato O, Iglesias M, Radosevic A, Ilzarbe L, et al. Comparison of Perioperative Outcomes Between Laparoscopic and Open Approach for Pancreatoduodenectomy: The PADULAP Randomized Controlled Trial. Ann Surg. 2018;268(5):731-9.
doi: 10.1097/SLA.0000000000002893
pubmed: 30138162
van Hilst J, de Rooij T, Bosscha K, Brinkman DJ, van Dieren S, Dijkgraaf MG, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol. 2019;4(3):199-207.
doi: 10.1016/S2468-1253(19)30004-4
pubmed: 30685489
Wang M, Li D, Chen R, Huang X, Li J, Liu Y, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol. 2021;6(6):438-47.
doi: 10.1016/S2468-1253(21)00054-6
pubmed: 33915091
Boone BA, Zenati M, Hogg ME, Steve J, Moser AJ, Bartlett DL, et al. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg. 2015;150(5):416-22.
doi: 10.1001/jamasurg.2015.17
pubmed: 25761143
Muller PC, Breuer E, Nickel F, Zani S, Jr., Kauffmann E, De Franco L, et al. Robotic Distal Pancreatectomy, a Novel Standard of Care? Benchmark Values for Surgical Outcomes from 16 International Expert Centers. Ann Surg. 2022.
Jin J, Shi Y, Chen M, Qian J, Qin K, Wang Z, et al. Robotic versus Open Pancreatoduodenectomy for Pancreatic and Periampullary Tumors (PORTAL): a study protocol for a multicenter phase III non-inferiority randomized controlled trial. Trials. 2021;22(1):954.
doi: 10.1186/s13063-021-05939-6
pubmed: 34961558
pmcid: 8711152
Burke EE, Marmor S, Portschy PR, Virnig BA, Cho LC, Tuttle TM, et al. Trends in the use of pre-operative radiation for adenocarcinoma of the pancreas in the United States. HPB (Oxford). 2015;17(6):542-50.
doi: 10.1111/hpb.12400
pubmed: 25726950
pmcid: 4430786
Cooper AB, Parmar AD, Riall TS, Hall BL, Katz MHG, Aloia TA, et al. Does the Use of Neoadjuvant Therapy for Pancreatic Adenocarcinoma Increase Postoperative Morbidity and Mortality Rates? Journal of Gastrointestinal Surgery. 2015;19(1):80-7.
doi: 10.1007/s11605-014-2620-3
pubmed: 25091851
Czosnyka NM, Borgert AJ, Smith TJ. Pancreatic adenocarcinoma: effects of neoadjuvant therapy on post-pancreatectomy outcomes - an American College of Surgeons National Surgical Quality Improvement Program targeted variable review. HPB (Oxford). 2017;19(10):927-32.
doi: 10.1016/j.hpb.2017.07.001
pubmed: 28747265
Badiyan SN, Molitoris JK, Chuong MD, Regine WF, Kaiser A. The Role of Radiation Therapy for Pancreatic Cancer in the Adjuvant and Neoadjuvant Settings. Surg Oncol Clin N Am. 2017;26(3):431-53.
doi: 10.1016/j.soc.2017.01.012
pubmed: 28576181
Sohal DPS, Duong M, Ahmad SA, Gandhi NS, Beg MS, Wang-Gillam A, et al. Efficacy of Perioperative Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Phase 2 Randomized Clinical Trial. JAMA Oncology. 2021;7(3):421-7.
doi: 10.1001/jamaoncol.2020.7328
pubmed: 33475684
Nassour I, Tohme S, Hoehn R, Adam MA, Zureikat AH, Alessandro P. Safety and oncologic efficacy of robotic compared to open pancreaticoduodenectomy after neoadjuvant chemotherapy for pancreatic cancer. Surg Endosc. 2021;35(5):2248-54.
doi: 10.1007/s00464-020-07638-w
pubmed: 32440928