Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

Russell, Thomas; Smith, Andrew M.; Silva, Michael A.; Aroori, Somaiah; Labib, Peter; Streeter, Adam; Denson, Jemimah; Puckett, Mark; Zhou, Shang‐Ming; Browning, Matthew G.; Ausania, Fabio; Pando, Elizabeth; Roberts, Keith; Kausar, Ambareen; Marangoni, Gabriele; Thomasset, Sarah; Frampton, Adam E.; Lykoudis, Pavlos; Maglione, Manuel; Alhaboob, Nassir; Bari, Hassaan; Smith, Andrew M.; Spalding, Duncan; Srinivasan, Parthi; Davidson, Brian R; Bhogal, Ricky H.; Croagh, Daniel; Domínguez, Ismael; Thakkar, Rohan; Gomez, Dhanny; Silva, Michael; Lapolla, Pierfrancesco; Mingoli, Andrea; Porcu, Alberto; Shah, Namrata; Hamady, Zaed; Al-Sarrieh, Bilal; Serrablo, Alejandro; González-Abós, Carolina; Fernandes, Nair; Moller, Elsa Garcia; Taboada, Cristina Dopazo; Pandé, Rupaly; Alfarah, Jameel; Bandyopadhyay, Samik; Abdel-Rahim, Ahmed; Khan, Ayesha; Jordan, Caitlin; Rees, Jonathan; Blege, Harry; Cambridge, William; White, Olga; Blacker, Sarah; Blackburn, Jessie; Sweeney, Casie; Field, Daniel J.; Gouda, Mohammed K.; Bellotti, Ruben; Hamid, Hytham K. S.; Hassan, Ahmed; Moriarty, Catherine; White, Louise G.; Priestley, Mark; Bode, Kerry; Sharp, Judith A.; Wragg, Rosie; Jackson, Beverley; Craven, Samuel J.; Fehervari, Matyas; Pai, Madhava; Alghazawi, Laith; Onifade, Anjola; Ribaud, Julliette; Nair, Ashitha; Mariathasan, Michael; Grayson, Niamh; Pericleous, Stephanos; Patel, Krishna; Shaw, Conrad; Morare, Nolitha; Zaban, Mohamad Khish; Doyle, Joseph; Mavroeidis, Vasileios; Guerrero, Alan D.; Moguel, Andre; Chan, Carlos; Jones, Michael; Buckley, Edward G.; Akter, Nasreen; Treherne, Kyle; Gordon, Gregory S.; Hughes, Daniel; Urbonas, Tomas; Brachini, Gioia; Caronna, Roberto; Chirletti, Piero; Perra, Teresa; Kahar, Nurul Nadhirah Abd; Hall, Thomas; Nadeem, Nabeegh; Karar, Shoura; Arshad, Ali; Yarwood, Adam; Hammoda, Mohammed; Artigas, María Soler; Paterna-López, Sandra

doi:10.1016/j.ejso.2023.04.018

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…According to a large-scale study, patients who experienced severe POCs, specifically those with a CD grade ≥3, were reported to initiate AC less frequently after pancreatic surgery [ 50 ]. Furthermore, it has been demonstrated that CAR serves as a valuable predictor of POCs following pancreatic resection [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein-to-Albumin Ratio to Predict Tolerability of S-1 as an Adjuvant Chemotherapy in Pancreatic Cancer

Funamizu,

Sakamoto,

Hikida

et al. 2024

Cancers

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Adjuvant chemotherapy (AC) with S-1 after radical surgery for resectable pancreatic cancer (PC) has shown a significant survival advantage over surgery alone. Consequently, ensuring that patients receive a consistent, uninterrupted S-1 regimen is of paramount importance. This study aimed to investigate whether the C-reactive protein-to-albumin ratio (CAR) could predict S-1 AC completion in PC patients without dropout due to adverse events (AEs). We retrospectively enrolled 95 patients who underwent radical pancreatectomy and S-1 AC for PC between January 2010 and December 2022. A statistical analysis was conducted to explore the correlation of predictive markers with S-1 completion, defined as continuous oral administration for 6 months. Among the 95 enrolled patients, 66 (69.5%) completed S-1, and 29 (30.5%) failed. Receiver operating characteristic curve analysis revealed 0.05 as the optimal CAR threshold to predict S-1 completion. Univariate and multivariate analyses further validated that a CAR ≥ 0.05 was independently correlated with S-1 completion (p < 0.001 and p = 0.006, respectively). Furthermore, a significant association was established between a higher CAR at initiation of oral administration and acceptable recurrence-free and overall survival (p = 0.003 and p < 0.001, respectively). CAR ≥ 0.05 serves as a predictive marker for difficulty in completing S-1 treatment as AC for PC due to AEs.

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Section: Discussionmentioning

confidence: 99%

C-Reactive Protein-to-Albumin Ratio to Predict Tolerability of S-1 as an Adjuvant Chemotherapy in Pancreatic Cancer

Funamizu,

Sakamoto,

Hikida

et al. 2024

Cancers

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“…Although there was no difference in receiving adjuvant treatment according to the severity of complications, the occurrence of CD ≥ 3 complications caused a significant delay in initiating this treatment, as previously demonstrated. 20 Regarding pathology outcomes, recent publications demonstrated that RDP could have a higher likelihood of achieving R0 margins than LDP. 6 In our study, we found a relevant difference in achieving negative margins (78.4% in RDP vs. 65.9% in LDP), although it did not reach statistical significance.…”

Section: Variablesmentioning

confidence: 99%

Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

Ausania,

Landi,

González‐Abós

et al. 2023

Robotics Computer Surgery

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BackgroundRobotic distal pancreatectomy (RDP) is associated with a lower conversion rate and less blood loss than laparoscopic distal pancreatectomy (LDP). LDP has similar oncological outcomes as open surgery in PDAC. The aim of this study was to compare perioperative and oncological outcomes in obese patients with RDP versus LDP for PDAC.Materials and methodsRetrospectively, all obese patients who underwent RDP or LDP for PDAC between 2012 and 2022 at 12 international expert centres were included.Resultsout of 372, 81 patients were included. All baseline features were comparable between the two groups. RDP was associated with decreased blood loss (495mlLDP vs. 188mlRDP; p = 0.003), lower conversion rate (13.5%RDP vs. 36.4%LDP; p = 0.019) and lower rate of Clavien‐Dindo ≥3 complications (13.5%RDP vs. 36.4%LDP; p = 0.019). Overall and disease‐free survival were comparable.ConclusionsIn obese patients with left‐sided PDAC, the robotic approach was associated with improved intraoperative outcomes and fewer severe complications.

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“…For patients at high risk of developing postoperative complications after PD, a situation that may impact access to adjuvant therapy in patients with malignancies, a neoadjuvant treatment should be taken into consideration to improve oncological long-term outcomes [22,23]. Nevertheless, a study published in 2023 showed statistically significantly higher rates of malignancies with the use of neoadjuvant therapies in patients with PD and concurrent colectomies compared with the standard PD group of patients [27].…”

Section: Oncological Outcomes Of Pd With Concurrent Colectomiesmentioning

confidence: 99%

“…Postoperative complications impact patients' early outcomes and quality of life after PD/colectomies (slow postoperative recovery) and may harm oncological outcomes. Thus, severe postoperative complications correlate with delayed, incomplete, or even lower adjuvant chemotherapy rates in patients with PD for malignancies (mainly but not exclusively PDAC), which is a situation associated with increased recurrence rates and decreased survivals [22,23]. Furthermore, the development of significant morbidities after curative surgery for colon cancer is associated with increased recurrence rates and worse long-term survivals [24].…”

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomies with Concurrent Colectomies: Indications, Technical Issues, Complications, and Oncological Outcomes

Dumitrascu

2023

JCM

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Multi-visceral resections for colon and pancreatic cancer (PDAC) are feasible, safe, and justified for early and late outcomes. However, the use of pancreaticoduodenectomy (PD) with concurrent colectomies is highly debatable in terms of morbidity and oncological benefits. Based on current literature data, this review assesses the early and long-term outcomes of PD with colectomies. The association represents a challenging but feasible option for a few patients with PDAC or locally advanced right colon cancer when negative resection margins are anticipated because long-term survival can be achieved. Concurrent colectomies during PD should be cautiously approached because they may significantly increase complication rates, including severe ones. Thus, patients should be fit enough to overcome potential severe complications. Patients with PD and colectomies can be classified as borderline resectable, considering the high risk of developing postoperative complications. Carefully selecting patients suitable for PD with concurrent colectomies is paramount to mitigate the potentially severe complications of the two surgical procedures and maximize the oncological benefits. These procedures should be performed at high-volume centers with extensive experience in pancreatectomies and colectomies, and each patient situation should be assessed using a multimodal approach, including high-quality imaging and neoadjuvant therapies, in a multidisciplinary team discussion.

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Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

Cited by 6 publications

References 21 publications

C-Reactive Protein-to-Albumin Ratio to Predict Tolerability of S-1 as an Adjuvant Chemotherapy in Pancreatic Cancer

C-Reactive Protein-to-Albumin Ratio to Predict Tolerability of S-1 as an Adjuvant Chemotherapy in Pancreatic Cancer

Robotic versus laparoscopic distal pancreatectomy for pancreatic adenocarcinoma in obese patients

Pancreaticoduodenectomies with Concurrent Colectomies: Indications, Technical Issues, Complications, and Oncological Outcomes

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