Surgical Outcome After Pancreatoduodenectomy for Duodenal Adenocarcinoma Compared with Other Periampullary Cancers: A Nationwide Audit Study

Abstract

Background Surgical outcome after pancreatoduodenectomy for duodenal adenocarcinoma could differ from pancreatoduodenectomy for other cancers, but large multicenter series are lacking. This study aimed to determine surgical outcome in patients after pancreatoduodenectomy for duodenal adenocarcinoma, compared with other periampullary cancers, in a nationwide multicenter cohort. Methods After pancreatoduodenectomy for cancer between 2014 and 2019, consecutive patients were included from the nationwide, mandatory Dutch Pancreatic Cancer Audit. Patients were stratified by diagnosis. Baseline, treatment characteristics, and postoperative outcome were compared between groups. The association between diagnosis and major complications (Clavien–Dindo grade III or higher) was assessed via multivariable regression analysis. Results Overall, 3113 patients, after pancreatoduodenectomy for cancer, were included in this study: 264 (8.5%) patients with duodenal adenocarcinomas and 2849 (91.5%) with other cancers. After pancreatoduodenectomy for duodenal adenocarcinoma, patients had higher rates of major complications (42.8% vs. 28.6%; p < 0.001), postoperative pancreatic fistula (International Study Group of Pancreatic Surgery [ISGPS] grade B/C; 23.1% vs. 13.4%; p < 0.001), complication-related intensive care admission (14.3% vs. 10.3%; p = 0.046), re-interventions (39.8% vs. 26.6%; p < 0.001), in-hospital mortality (5.7% vs. 3.1%; p = 0.025), and longer hospital stay (15 days vs. 11 days; p < 0.001) compared with pancreatoduodenectomy for other cancers. In multivariable analysis, duodenal adenocarcinoma was independently associated with major complications (odds ratio 1.14, 95% confidence interval 1.03–1.27; p = 0.011). Conclusion Pancreatoduodenectomy for duodenal adenocarcinoma is associated with higher rates of major complications, pancreatic fistula, re-interventions, and in-hospital mortality compared with patients undergoing pancreatoduodenectomy for other cancers. These findings should be considered in patient counseling and postoperative management.

Ideal Outcome After Pancreatoduodenectomy

“…29 Only a few studies describe the increased risk of ampullary tumors, especially duodenal carcinoma, on complications. 30,31 In addition, neoadjuvant chemoradiotherapy therapy in patients with PDAC which is associated with better IO in the present study, reduces the risk of POPF and could thus improve the rate of IO. 32,33 Among others, within a retrospective study of 13,257 patients, neoadjuvant chemotherapy was associated with reduced severe morbidity, POPF, organ-space infections, percutaneous drainage, reoperation, and prolonged LOS.…”

“…Patients with benign or premalignant neoplasms more often have a soft pancreas and nondilated pancreatic duct, which are both well-known risk factors for pancreatic fistula and intra-abdominal infections 29 . Only a few studies describe the increased risk of ampullary tumors, especially duodenal carcinoma, on complications 30,31 . In addition, neoadjuvant chemoradiotherapy therapy in patients with PDAC which is associated with better IO in the present study, reduces the risk of POPF and could thus improve the rate of IO 32,33 .…”