50 - Communication libre
3 juin 2021, 13:50 - 15:20, Stream 2: SSCViscérale
Major postoperative complications increase tumor recurrence rate and diminish long-term survival following resection for pancreatic ductal adenocarcinoma
A. Andreou, P. Aeschbacher, A. S. Wenning, D. Candinas, B. Gloor, Presenter: A. Andreou (Bern)
Major complications have been associated with worse oncologic outcomes following resection for several gastrointestinal malignancies. However, the impact of major postoperative morbidity on the survival of patients undergoing resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear.
Clinicopathological data of patients who underwent resection for PDAC between 2014 and 2019 in a major swiss hepatopancreatobiliary center were assessed. We evaluated the disease-free (DFS) and overall survival (OS) of patients suffering a major postoperative complication (grade-3 or higher within 90 days according to Clavien-Dindo classification) in comparison to those of patients without any major postoperative adverse events.
During the study period, 186 patients underwent resection for PDAC with curative intent. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 66%, 12%, and 22% of patients, respectively. Major 90-day postoperative morbidity and mortality rate were 21.5% and 4.3%, respectively. After excluding patients who died within 90 days, major postoperative morbidity significantly increased the length of hospital stay [median 22 (8-66) days vs. 13 (5-26) days, p < 0.0001] resulting in a delay of returning to intended oncologic treatment and reducing the likelihood of receiving adjuvant chemotherapy (56% vs. 83%, p = 0.001). Postoperative major complications were associated with significantly worse DFS (median DFS 10 vs. 16 months, hazard ratio 1.9, 95% confidence interval 1.91-2.96, p = 0.004) and worse OS (median OS 14 vs. 37 months, hazard ratio 1.7, 95% confidence interval 1.02-2.75, p = 0.04) in multivariate analysis.
Major postoperative complications promote tumor recurrence following resection for PDAC, thus limiting long-term survival. Careful patient selection and optimized complication management may reduce postoperative morbidity, thereby lowering its negative impact on oncologic prognosis.