Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1663
Peer-review started: March 29, 2023
First decision: April 26, 2023
Revised: May 12, 2023
Accepted: June 12, 2023
Article in press: June 12, 2023
Published online: August 27, 2023
Processing time: 148 Days and 21.6 Hours
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.
To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.
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.
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.
Neoadjuvant radiotherapy, while not associated with increased mortality, will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.
Core Tip: In this retrospective study, we used a national database to investigate the impact that neoadjuvant radiotherapy has on intraoperative and 30-d post-operative outcomes among patients undergoing surgical resection for pancreatic adenocarcinoma. We found that neoadjuvant radiotherapy was associated with longer operative times and the more frequent need for perioperative blood transfusions, but not with increased 30-d mortality. Neoadjuvant radiotherapy was also associated with a lower number of organ space infections and post-operative pancreatic fistula formation. Taken together, the results highlight the challenges that surgeons may face when operating in previously irradiated fields.