Standard-Adherent Surgery and Guideline-Based Therapy in Pancreatic Cancer: A Multicenter Analysis

Optimal outcomes in pancreatic adenocarcinoma (PDAC) rely on a multidisciplinary approach consisting of both curative-intent resection and systemic therapy. This study aimed to investigate the factors associated with adherence to standard-adherent surgery (SAS) and guideline-recommended therapy (GRT) and their impact on survival outcomes.

This study retrospectively analyzed a multicenter database of patients who underwent resection for PDAC between 2014 and 2023. The study defined SAS as pancreatic resection with negative margins and examination of 15 or more lymph nodes. Stage-specific GRT was performed according to the National Comprehensive Cancer Network (NCCN) guidelines.

Among the 424 patients with PDAC who underwent resection, 63 (15%) received SAS, 111 (26%) received GRT, and 169 (40%) achieved both. The patients in the SAS plus GRT group had fewer severe postoperative complications (Clavien-Dindo grade III+) (18.0 vs. 25.3%; p = 0.027), lower recurrence rates (45.2 vs. 51.4%; p = 0.023), and reduced short-term mortality, including lower 30-day (0.6 vs. 4.0%; p = 0.037) and 90-day (2.6 vs. 7.7%; p = 0.032) mortality rates. Multivariable logistic regression identified tumor size of 3 cm or larger (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.46-0.83; p = 0.040) and Charlson Comorbidity Index (CCI) of 2 or higher (OR, 0.69; 95% CI, 0.46-0.88; p = 0.045) as independent predictors of lower adherence to both SAS and GRT. The patients who received both SAS and GRT also had significantly better OS (hazard ratio [HR], 0.79; 95% CI, 0.53-0.92; p = 0.041) and recurrence-free survival (RFS) than those who did not.

The patients who met both the SAS and GRT criteria after PDAC resection had significantly fewer postoperative complications and longer survival, but only 40% of the patients received both.