术后并发症减少了可切除胰腺癌辅助化疗的使用。

Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer.

作者信息

Merkow Ryan P, Bilimoria Karl Y, Tomlinson James S, Paruch Jennifer L, Fleming Jason B, Talamonti Mark S, Ko Clifford Y, Bentrem David J

机构信息

*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.

出版信息

Ann Surg. 2014 Aug;260(2):372-7. doi: 10.1097/SLA.0000000000000378.

DOI:10.1097/SLA.0000000000000378

PMID:24374509

Abstract

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.

摘要

目的

评估术后并发症对辅助化疗接受情况的影响。

背景

随机试验表明辅助化疗与长期生存率提高相关。然而，胰腺手术会导致显著的发病率，并发症对后续治疗选择的限制程度尚不清楚。

方法

将美国外科医师学会国家外科质量改进计划和国家癌症数据库中接受胰腺癌切除术的患者进行关联分析（2006 - 2009年）。采用多变量回归方法评估并发症与辅助化疗使用或治疗延迟（术后≥70天）之间的关联。

结果

来自149家医院的2047例患者接受了I - III期胰腺腺癌切除术，其中23.2%至少有1种严重并发症。总体辅助化疗接受率为57.7%：无任何并发症的患者中为61.8%，有严重并发症的患者中为43.6%。严重并发症使未接受辅助治疗的可能性增加两倍多[比值比（OR）= 2.20，95%置信区间（CI）：1.73 - 2.80]。与未进行辅助化疗相关的特定并发症包括再次插管（OR = 7.79，95% CI：3.59 - 16.87）、通气时间延长（OR = 5.92，95% CI：3.23 - 10.86）、肺炎（OR = 2.83，95% CI：1.63 - 4.90）、脓毒症/休克（OR = 2.76，95% CI：2.02 - 3.76）、器官间隙/深部手术部位感染（OR = 2.19，95% CI：1.53 - 3.13）、静脉血栓栓塞（OR = 1.92，95% CI：1.08 - 3.43）和尿路感染（OR = 1.61，95% CI：1.02 - 2.54）。严重并发症也使辅助治疗延迟的可能性增加一倍（OR = 2.08，95% CI：1.42 - 3.05）。在更年轻、更健康的患者队列中进行的敏感性分析显示了类似的关联。