Davis Catherine H, Beane Joal D, Gazivoda Victor P, Grandhi Miral S, Greenbaum Alissa A, Kennedy Timothy J, Langan Russell C, August David A, Alexander H Richard, Pitt Henry A
From the Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ (Davis, Gazivoda, Grandhi, Greenbaum, Kennedy, Langan, August, Alexander, Pitt).
Department of Surgery, Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ (Davis, Gazivoda, Grandhi, Greenbaum, Kennedy, Langan, August, Alexander, Pitt).
J Am Coll Surg. 2022 Apr 1;234(4):436-443. doi: 10.1097/XCS.0000000000000095.
The introduction of more effective chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to assess the evolving use of NAT in individuals with PDAC undergoing pancreatoduodenectomy (PD) and to compare their outcomes with patients undergoing upfront operation.
The American College of Surgeons NSQIP Procedure Targeted Pancreatectomy database was queried from 2014 to 2019. Patients undergoing pancreatoduodenectomy were evaluated based on the use of NAT versus upfront operation. Multivariable analysis was performed to determine the effect of NAT on postoperative outcomes, including the composite measure optimal pancreatic surgery (OPS). Mann-Kendall trend tests were performed to assess the use of NAT and associated outcomes over time.
A total of 13,257 patients were identified who underwent PD for PDAC between 2014 and 2019. Overall, 33.6% of patients received NAT. The use of NAT increased steadily from 24.2% in 2014 to 42.7% in 2019 (p < 0.0001). On multivariable analysis, NAT was associated with reduced serious morbidity (odds ratio [OR] 0.83, p < 0.001), clinically relevant pancreatic fistulas (OR 0.52, p < 0.001), organ space infections (OR 0.74, p < 0.001), percutaneous drainage (OR 0.73, p < 0.001), reoperation (OR 0.76, p = 0.005), and prolonged length of stay (OR 0.63, p < 0.001). OPS was achieved more frequently in patients undergoing NAT (OR 1.433, p < 0.001) and improved over time in patients receiving NAT (50.7% to 56.6%, p < 0.001).
NAT before pancreatoduodenectomy increased more than 3-fold over the past decade and was associated with improved optimal operative outcomes.
十年前引入更有效的化疗方法后，胰腺导管腺癌（PDAC）患者新辅助治疗（NAT）的使用有所增加。本研究的目的是评估接受胰十二指肠切除术（PD）的PDAC患者中NAT的使用变化情况，并将其结果与直接进行手术的患者进行比较。
查询了美国外科医师学会NSQIP程序靶向胰腺切除术数据库2014年至2019年的数据。根据是否使用NAT或直接手术对接受胰十二指肠切除术的患者进行评估。进行多变量分析以确定NAT对术后结果的影响，包括综合指标最佳胰腺手术（OPS）。进行Mann-Kendall趋势检验以评估NAT的使用情况及其相关结果随时间的变化。
共确定了13257例在2014年至2019年间因PDAC接受PD手术的患者。总体而言，33.6%的患者接受了NAT。NAT的使用从2014年的24.2%稳步增加到2019年的42.7%（p<0.0001）。多变量分析显示，NAT与严重并发症减少相关（比值比[OR]0.83，p<0.001）、临床相关胰瘘减少（OR 0.52，p<0.001）、器官腔隙感染减少（OR 0.74，p<0.001）、经皮引流减少（OR 0.73，p<0.001）、再次手术减少（OR 0.76，p = 0.005）以及住院时间延长减少（OR 0.63，p<0.001）。接受NAT的患者更频繁地实现了OPS（OR 1.433，p<0.001），并且接受NAT的患者随时间推移OPS情况有所改善（从50.7%提高到56.6%，p<0.001）。
在过去十年中，胰十二指肠切除术前行NAT的情况增加了3倍多，且与更好的最佳手术结果相关。
