Division of Surgical Oncology, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA.
Ann Surg Oncol. 2023 Aug;30(8):5027-5034. doi: 10.1245/s10434-023-13533-0. Epub 2023 May 20.
Guidelines for perioperative systemic therapy administration in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma (PDAC) and distal cholangiocarcinoma (dCCA) are evolving. Decisions regarding adjuvant therapy are influenced by postoperative morbidity, which is common after pancreatoduodenectomy. We evaluated whether postoperative complications are associated with receipt of adjuvant therapy after pancreatoduodenectomy.
A retrospective analysis of patients undergoing pancreatoduodenectomy for PDAC or dCCA from 2015 to 2020 was conducted. Demographic, clinicopathologic, and postoperative variables were analyzed.
Overall, 186 patients were included-145 with PDAC and 41 with dCCA. Postoperative complication rates were similar for both pathologies (61% and 66% for PDAC and dCCA, respectively). Major postoperative complications (MPCs), defined as Clavien-Dindo >3, occurred in 15% and 24% of PDAC and dCCA patients, respectively. Patients with MPCs received lower rates of adjuvant therapy administration, irrespective of primary tumor (PDAC: 21 vs. 72%, p = 0.008; dCCA: 20 vs. 58%, p = 0.065). Recurrence-free survival (RFS) was worse for patients with PDAC who experienced an MPC [8 months (interquartile range [IQR] 1-15) vs. 23 months (IQR 19-27), p < 0.001] or who did not receive any perioperative systemic therapy [11 months (IQR 7-15) vs. 23 months (IQR 18-29), p = 0.038]. In patients with dCCA, 1-year RFS was worse for patients who did not receive adjuvant therapy (55 vs. 77%, p = 0.038).
Patients who underwent pancreatoduodenectomy for either PDAC or dCCA and who experienced an MPC had lower rates of adjuvant therapy and worse RFS, suggesting that clinicians adopt a standard neoadjuvant systemic therapy strategy in patients with PDAC. Our results propose a paradigm shift towards preoperative systemic therapy in patients with dCCA.
针对接受胰十二指肠切除术（PDAC）和远端胆管癌（dCCA）治疗的胰腺腺癌患者围手术期全身治疗管理的指南正在不断发展。辅助治疗决策受到术后发病率的影响，PDAC 手术后发病率很常见。我们评估了手术后并发症是否与 PDAC 手术后接受辅助治疗有关。
对 2015 年至 2020 年期间接受 PDAC 或 dCCA 胰十二指肠切除术的患者进行了回顾性分析。分析了患者的人口统计学、临床病理学和术后变量。
共纳入 186 例患者，其中 145 例为 PDAC，41 例为 dCCA。两种病变的术后并发症发生率相似（PDAC 为 61%，dCCA 为 66%）。主要术后并发症（MPC，定义为 Clavien-Dindo >3）在 PDAC 和 dCCA 患者中的发生率分别为 15%和 24%。发生 MPC 的患者接受辅助治疗的比例较低，而不论原发肿瘤如何（PDAC：21% vs. 72%，p = 0.008；dCCA：20% vs. 58%，p = 0.065）。发生 MPC 的 PDAC 患者的无复发生存率（RFS）更差[8 个月（四分位距 [IQR] 1-15）vs. 23 个月（IQR 19-27），p < 0.001]或未接受任何围手术期全身治疗的患者[11 个月（IQR 7-15）vs. 23 个月（IQR 18-29），p = 0.038]。在 dCCA 患者中，未接受辅助治疗的患者 1 年 RFS 更差（55% vs. 77%，p = 0.038）。
接受 PDAC 或 dCCA 胰十二指肠切除术且发生 MPC 的患者辅助治疗率较低，RFS 较差，这表明临床医生应在 PDAC 患者中采用标准的新辅助全身治疗策略。我们的结果提出了一种向 dCCA 患者术前全身治疗的范式转变。
