Preoperative Chemotherapy Does Not Impact Failure to Rescue in Patients Undergoing Pancreatectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Medical Oncology

Background:

• The impact of preoperative chemotherapy (PC) on pancreatic adenocarcinoma outcomes is under investigation.
• Failure to rescue (FTR) and surgical outcomes are key metrics for evaluating treatment efficacy.

Purpose of the Study:

• To investigate the rate of FTR and surgical outcomes in patients undergoing pancreatectomy.
• To compare outcomes between patients receiving PC within 90 days and those not receiving PC.

Main Methods:

• Utilized the National Surgical Quality Improvement Program Targeted Dataset for Pancreatectomy (2014-2020).
• Identified patients with malignant non-neuroendocrine pancreatic tumors who underwent pancreatectomy.
• Employed propensity score analysis to match 7895 patients with PC to 7895 patients without PC based on clinical factors.
• Defined FTR as mortality following a major complication (Clavien-Dindo Class III-V).

Main Results:

• Patients receiving PC had a significantly lower FTR rate (P = 0.002) compared to those without PC.
• PC was associated with a lower rate of overall complications (P < 0.001), particularly in the pancreaticoduodenectomy subgroup (P < 0.009).
• PC patients were more likely to require vascular resection (P < 0.001) despite higher American Society of Anesthesiology (ASA) scores.

Conclusions:

• Preoperative chemotherapy within 90 days prior to pancreatectomy is linked to reduced FTR and overall complications.
• These findings suggest that PC does not adversely affect surgical outcomes in pancreatic cancer patients when administered appropriately.
• The study highlights the potential benefits of integrating PC into treatment protocols for pancreatic adenocarcinoma.