Effects of duration of initial treatment on postoperative complications in pancreatic cancer

We analyzed the clinical impact of chemotherapy or chemoradiotherapy as initial treatment (IT), focusing on treatment duration, on morbidity and mortality in patients with resected pancreatic ductal adenocarcinoma.

We enrolled 509 consecutive patients, with 417 in the upfront surgery group and 92 in the IT group. The IT group was subdivided into 72 patients treated for <8 months and 20 treated ≥8 months. We compared rates of postoperative Clavien-Dindo grade ≥III complications between the groups. Multivariate logistic regression analysis was used to find independent predictors of complications.

The upfront surgery and IT groups did not significantly differ in overall postsurgical complications. In contrast, rates of overall complications significantly differed between the <8 months and ≥8 months IT groups, although their background clinical factors did not differ. In multivariate analysis, operative procedure (distal pancreatectomy and distal pancreatectomy with celiac axis resection) (odds ratio [OR] 6.950, P = 0.0416) and IT ≥8 months (OR 4.508, P = 0.0156) were independent predictive factors for postoperative complications.

Postoperative complications were significantly higher in the ≥8 months IT group, and multivariate analysis demonstrated that operative procedure and ≥8 months IT were independent predictive factors.