Related Experiment Video
Updated: May 4, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer
Ryan P Merkow1, Karl Y Bilimoria, James S Tomlinson
1*Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; †Surgical Outcomes and Quality Improvement Center and the Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL; ‡Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL; §Department of Surgery, University of California, Los Angeles and VA Greater Los Angeles Healthcare System, Los Angeles, CA; ¶Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX; ‖Department of Surgery, Northshore University Health System, Evanston, IL; and **Department of Surgery, Jesse Brown Veteran Affairs Medical Center, Chicago, IL.
Objective:
To assess the impact of postoperative complications on the receipt of adjuvant chemotherapy.
Background:
Randomized trials have demonstrated that adjuvant chemotherapy is associated with improved long-term survival. However, pancreatic surgery is associated with significant morbidity and the degree to which complications limit subsequent treatment options is unknown.
Methods:
Patients from the American College of Surgeons National Surgical Quality Improvement Program and the National Cancer Data Base who underwent pancreatic resection for cancer were linked (2006-2009). The associations between complications and adjuvant chemotherapy use or treatment delay (≥ 70 days from surgery) were assessed using multivariable regression methods.
Results:
From 149 hospitals, 2047 patients underwent resection for stage I-III pancreatic adenocarcinoma of which 23.2% had at least 1 serious complication. Overall adjuvant chemotherapy receipt was 57.7%: 61.8% among patients not experiencing any complication and 43.6% among those who had a serious complication. Serious complications increased the likelihood of not receiving adjuvant therapy over twofold [odds ratio (OR) = 2.20, 95% confidence interval (CI): 1.73-2.80]. Specific complications associated with adjuvant chemotherapy omission were reintubation (OR = 7.79, 95% CI: 3.59-16.87), prolonged ventilation (OR = 5.92, 95% CI: 3.23-10.86), pneumonia (OR = 2.83, 95% CI: 1.63-4.90), sepsis/shock (OR = 2.76, 95% CI: 2.02-3.76), organ space/deep surgical site infection (OR = 2.19, 95% CI: 1.53-3.13), venous thromboembolism (OR = 1.92, 95% CI: 1.08-3.43), and urinary tract infection (OR = 1.61, 95% CI: 1.02-2.54). Serious complications also doubled the likelihood of delaying adjuvant treatment administration (OR = 2.08, 95% CI: 1.42-3.05). Sensitivity analysis in a younger, healthier patient cohort demonstrated similar associations.
Conclusions:
Postoperative complications are common following pancreatic surgery and are associated with adjuvant chemotherapy omission and treatment delays.
More Related Videos
05:11Treatment of Middle-segment Pancreatic Benign Tumor Using Laparoscopic Central Pancreatectomy with End-to-end Pancreatic Duct Reconstruction
Published on: January 2, 2026
10:38DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020