Prognostic impact of postoperative infection in patients with pancreatic cancer: A multicenter cohort study

Okada, Kenjiro; Uemura, Kenichiro; Ohge, Hiroki; Iseki, Masahiro; Mizuma, Masamichi; Shinkawa, Hiroji; Takahata, Risa; Aoki, Taku; Makino, Kenta; Arai, Hiroki; Miyake, Toru; Takeda, Shigeru; Yokoyama, Yoshihiko; Yaguchi, Yoshihisa; Kobayashi, Minàko; Matsuda, Akihisa; Shiomi, Hisanori; Watanabe, Masamichi; Akagi, Shinji; Inoue, Toru; Tanemoto, Kazuo; Maruyama, Hiroshi

doi:10.1016/j.surg.2022.09.002

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…24,25 It has been reported that postoperative infectious complications indirectly worsen prognosis by decreasing the completion rate of adjuvant therapy. 26 As reported previously, lymph node metastasis is a strong prognostic factor. 25,27 However, preoperative imaging such as CT may not detect lymph node metastasis.…”

Section: Discussionmentioning

confidence: 68%

“…There have been several reports on the relationship between postoperative complications and prognosis in pancreatic cancer 24,25 . It has been reported that postoperative infectious complications indirectly worsen prognosis by decreasing the completion rate of adjuvant therapy 26 . As reported previously, lymph node metastasis is a strong prognostic factor 25,27 .…”

Section: Discussionmentioning

confidence: 85%

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Long‐term outcomes of neoadjuvant gemcitabine, nab‐paclitaxel, and S1 (GAS) in borderline resectable pancreatic cancer with arterial contact: Results from a phase II trial

Uemura,

Kondo,

Sudo

et al. 2023

J Hepato Biliary Pancreat

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Background/PurposeThis study reports the long‐term results of a phase II trial evaluating the clinical efficacy of neoadjuvant gemcitabine, nab‐paclitaxel, and S1 (GAS) in borderline resectable pancreatic cancer with arterial contact (BRPC‐A).MethodsA multicenter, single‐arm, phase II trial was conducted. Patients received six cycles of GAS and patients without progressive disease were intended for R0 resection.ResultsOf the 47 patients, 45 (96%) underwent pancreatectomy. At the time of this analysis, all patients were updated with no loss to follow‐up. A total of 30 patients died, while the remaining 17 patients were followed for a median of 68.1 months. The updated median overall survival (OS) was 41.0 months, with 2‐ and 5‐year OS rates of 68.0% and 44.6%, respectively. Multivariate analysis in the preoperative model showed that a tumor diameter reduction rate ≥10% and a CA19‐9 reduction rate ≥95% after neoadjuvant chemotherapy remained independently associated with favorable survival. In the postoperative multivariate model, no lymph node metastasis, no major surgical complications, and completion of adjuvant chemotherapy were independently associated with improved OS.ConclusionsThis long‐term evaluation of the neoadjuvant GAS trial demonstrated the high efficacy of the regimen, suggesting that it is a promising treatment option for patients with BRPC‐A.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 85%

Long‐term outcomes of neoadjuvant gemcitabine, nab‐paclitaxel, and S1 (GAS) in borderline resectable pancreatic cancer with arterial contact: Results from a phase II trial

Uemura,

Kondo,

Sudo

et al. 2023

J Hepato Biliary Pancreat

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“…Based on our findings, we consider that postponement of S-1 adjuvant chemotherapy initiation beyond 10 weeks after surgery should be limited to situations in which it is unavoidable or indicated. From the surgical perspective, a recent study has shown that postoperative infectious complications may worsen prognosis by preventing timely adjuvant therapy in PDAC patients [ 28 ]. Therefore, considerable care should be taken to prevent delays related to postoperative complications and the time required to resolve them, which can force a postponement.…”

Section: Discussionmentioning

confidence: 99%

Standard versus delayed initiation of S-1 adjuvant chemotherapy after surgery for pancreatic cancer: a secondary analysis of a nationwide cohort by the Japan Pancreas Society

Tomimaru¹,

Eguchi²,

Shimomura³

et al. 2023

J Gastroenterol

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Background Based on the Japan Adjuvant Study Group of Pancreatic Cancer-01 results, S-1 adjuvant chemotherapy has been the standard in resected pancreatic ductal adenocarcinoma (PDAC) patients in Japan and elsewhere, initiated within 10 weeks after surgery. To assess the clinical impact of this timing, we conducted a secondary analysis of a nationwide survey by the Japan Pancreas Society. Methods A total of 3361 patients were divided into two groups: 2681 (79.8%) initiating the therapy within 10 weeks after surgery (standard) and 680 (20.2%) after 10 weeks (delayed). We compared recurrence-free survival (RFS) and overall survival (OS) using the log-rank test and Cox proportional hazards model with conditional landmark analysis between the groups. Results were verified by adjustment with inverse-probability-of-treatment weighting (IPTW) analysis. Results The median timing of S-1 adjuvant chemotherapy initiation was 50 days (interquartile range: 38–66). In the standard group, 5-year RFS and OS rates were 32.3–48.7%, respectively, compared with 25.0–38.7% in the delayed group. Hazard ratios (HRs) and 95% confidence intervals were 0.84 (0.76–0.93) for RFS (p < 0.001) and 0.77 (0.69–0.87) for OS (p < 0.001). The IPTW analysis yielded 5-year RFS rates of 32.1% and 25.3% in the standard versus delayed group, respectively [HR = 0.86 (0.77–0.96), p < 0.001] and 5-year OS rates of 48.3% and 39.8%, respectively [HR = 0.81 (0.71–0.92), p < 0.001]. Conclusions Initiation of S-1 adjuvant chemotherapy in resected PDAC patients within 10 weeks after surgery may offer survival benefit over later initiation.

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“…However, surgical site infections (SSIs) and other healthcare-associated infections (HAIs) still occur at a high rate in patients undergoing pancreatic surgery as pivotal factors of increased hospital readmission and mortality rates [4] . Several studies have demonstrated that the incidence of SSIs following pancreatic surgery was 11.58%-26% [5][6][7][8] , while that of other HAIs after pancreatectomy was 4.33%-11.0% [9][10][11] . In addition, SSIs and other HAIs can contribute to more clinical burdens, prolong hospital stays, and elevate costs for patients undergoing pancreatic surgery [5,12] .…”

Section: Introductionmentioning

confidence: 99%

Antibiotic prophylaxis after 48 hours postoperatively are not associated with decreased surgical site infections and other healthcare associated infections in pancreatic surgery patients: a retrospective cohort study

Chen

et al. 2023

Preprint

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Background It is controversial whether antibiotic should be used prophylactically 48 hours after pancreatic surgery. Hence, We evaluated the association of antibiotic prophylaxis (AP) after 48 hours postoperatively with the incidence of surgical site infections (SSIs) and other healthcare-associated infections (HAIs) in patients receiving pancreatic surgery. Methods A retrospective cohort analysis was performed on 1073 patients who underwent pancreatic surgery. These patients were categorized into non-postoperative AP group (963) and postoperative AP group (110) based on whether or not they obtained AP from 48 hours to 30 days after surgery. Outcomes included SSIs and other HAIs. Results The incidence of SSIs was lower in the non-postoperative AP group (98/963, 10.2%) than in the postoperative AP group (22/110, 20.0%) (P = 0.002). Other HAIs incidence was not significantly different between the non-postoperative AP group (77/963, 8.0%) and the postoperative AP group (11/110, 10.0%) (P = 0.468). Multiple regression analysis demonstrated that postoperative AP was a risk factor for SSIs (OR = 2.14, 95%CI = 1.28–3.59) but not with other HAIs (OR = 1.24, 95%CI = 0.63–2.42) after adjustment for age, gender and diabetes. Subsequent to adjustment for all confounding factors, postoperative AP was not a risk factor for SSIs (OR = 2.42, 95%CI = 0.79–7.37) and other HAIs (OR = 4.10, 95%CI = 0.98–17.22). Conclusions Postoperative AP following pancreatic surgery was not associated with the lower morbidity rate of SSIs and other HAIs. Nonetheless, this study may facilitate further development of strategies towards standardization of the duration of AP management of pancreatic surgery.

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Prognostic impact of postoperative infection in patients with pancreatic cancer: A multicenter cohort study

Cited by 7 publications

References 22 publications

Long‐term outcomes of neoadjuvant gemcitabine, nab‐paclitaxel, and S1 (GAS) in borderline resectable pancreatic cancer with arterial contact: Results from a phase II trial

Long‐term outcomes of neoadjuvant gemcitabine, nab‐paclitaxel, and S1 (GAS) in borderline resectable pancreatic cancer with arterial contact: Results from a phase II trial

Standard versus delayed initiation of S-1 adjuvant chemotherapy after surgery for pancreatic cancer: a secondary analysis of a nationwide cohort by the Japan Pancreas Society

Antibiotic prophylaxis after 48 hours postoperatively are not associated with decreased surgical site infections and other healthcare associated infections in pancreatic surgery patients: a retrospective cohort study

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