Aploks Krist, Kim Minha, Stroever Stephanie, Ostapenko Alexander, Sim Young Bo, Sooriyakumar Ashwinkumar, Rahimi-Ardabily Arash, Seshadri Ramanathan, Dong Xiang Da
Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States.
Department of Research and Innovation, Nuvance Health, Danbury, CT 06810, United States.
World J Gastrointest Surg. 2023 Aug 27;15(8):1663-1672. doi: 10.4240/wjgs.v15.i8.1663.
Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States. In patients with "borderline resectable" disease, current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy. Although neoadjuvant radiotherapy may improve negative margin resection rate, it is theorized that its administration increases operative times and complexity.
To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.
Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set, who received a pancreaticoduodenectomy for pancreatic adenocarcinoma, were divided into two groups based off neoadjuvant radiotherapy status. Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy, perioperative blood transfusion status, total operative time, and other perioperative outcomes.
Of the 11458 patients included in the study, 1470 (12.8%) underwent neoadjuvant radiotherapy. Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion [adjusted odds ratio (aOR) = 1.58, 95% confidence interval (CI): 1.37-1.82; < 0.001] and have longer surgeries (insulin receptor-related receptor = 1.14, 95%CI: 1.11-1.16; < 0.001), while simultaneously having lower rates of organ space infections (aOR = 0.80, 95%CI: 0.66-0.97; = 0.02) and pancreatic fistula formation (aOR = 0.50, 95%CI: 0.40-0.63; < 0.001) compared to those who underwent surgery alone.
Neoadjuvant radiotherapy, while not associated with increased mortality, will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.
胰腺癌目前是美国癌症相关死亡的第四大主要原因。对于患有“可切除边缘”疾病的患者，目前美国国立综合癌症网络指南建议在胰十二指肠切除术之前使用新辅助放化疗。尽管新辅助放疗可能提高切缘阴性切除率，但理论上其应用会增加手术时间和复杂性。
探讨新辅助放疗与接受胰腺癌胰十二指肠切除术患者的30天发病率和死亡率结局之间的关联。
将2015 - 2019年国家外科质量改进计划数据集中接受胰腺癌胰十二指肠切除术的患者，根据新辅助放疗状态分为两组。采用多变量回归来确定新辅助放疗、围手术期输血状态、总手术时间和其他围手术期结局之间是否存在显著相关性。
在纳入研究的11458例患者中，1470例（12.8%）接受了新辅助放疗。接受新辅助放疗的患者更有可能需要围手术期输血[校正比值比（aOR）= 1.58，95%置信区间（CI）：1.37 - 1.82；P < 0.001]，并且手术时间更长（aOR = 1.14，95%CI：1.11 - 1.16；P < 0.001），而与单纯接受手术的患者相比，同时器官腔隙感染率较低（aOR = 0.80，95%CI：0.66 - 0.97；P = 0.02）以及胰瘘形成率较低（aOR = 0.50，95%CI：0.40 - 0.63；P < 0.001）。
新辅助放疗虽然与死亡率增加无关，但会影响胰腺癌患者手术切除的复杂性。
Zotero 插件