Tara M Mackay1, F Jasmijn Smits2, Daphne Roos3, Bert A Bonsing4, Koop Bosscha5, Olivier R Busch1, Geert-Jan Creemers6, Ronald M van Dam7, Casper H J van Eijck8, Michael F Gerhards9, Jan Willem B de Groot10, Bas Groot Koerkamp8, Nadia Haj Mohammad11, Erwin van der Harst12, Ignace H J T de Hingh13, Marjolein Y V Homs14, Geert Kazemier15, Mike S L Liem16, Vincent E de Meijer17, I Quintus Molenaar11, Vincent B Nieuwenhuijs18, Hjalmar C van Santvoort11, George P van der Schelling19, Martijn W J Stommel20, Albert Jan Ten Tije21, Judith de Vos-Geelen22, Fennie Wit23, Johanna W Wilmink24, Hanneke W M van Laarhoven24, Marc G Besselink25. 1. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 2. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 3. Department of Surgery, Reinier de Graaf Group, Delft, the Netherlands. 4. Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands. 5. Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands. 6. Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands. 7. Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands. 8. Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. 9. Department of Surgery, OLVG, Amsterdam, the Netherlands. 10. Oncology Center Isala, Zwolle, the Netherlands. 11. Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands. 12. Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands. 13. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 14. Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands. 15. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, VU Medical Center, Amsterdam, the Netherlands. 16. Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. 17. Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands. 18. Department of Surgery, Isala, Zwolle, the Netherlands. 19. Department of Surgery, Amphia Hospital, Breda, the Netherlands. 20. Department of Surgery, Radboud UMC, Nijmegen, the Netherlands. 21. Department of Medical Oncology, Amphia Hospital, Breda, the Netherlands. 22. Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, the Netherlands. 23. Department of Surgery, Tjongerschans, Heerenveen, the Netherlands. 24. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. 25. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands. Electronic address: m.g.besselink@amc.nl.
Abstract
BACKGROUND: The relation between type of postoperative complication and not receiving chemotherapy after resection of pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim was to investigate which patient factors and postoperative complications were associated with not receiving adjuvant chemotherapy. METHODS: Patients who underwent resection (2014-2017) for PDAC were identified from the nationwide mandatory Dutch Pancreatic Cancer Audit. The association between patient-, tumor-, center-, treatment characteristics, and the risk of not receiving adjuvant chemotherapy was analyzed with multivariable logistic regression. RESULTS: Overall, of 1306 patients, 24% (n = 312) developed postoperative Clavien Dindo ≥3 complications. In-hospital mortality was 3.5% (n = 46). Some 433 patients (33%) did not receive adjuvant chemotherapy. Independent predictors (all p < 0.050) for not receiving adjuvant chemotherapy were older age (odds ratio (OR) 0.96), higher ECOG performance status (OR 0.57), postoperative complications (OR 0.32), especially grade B/C pancreatic fistula (OR 0.51) and post-pancreatectomy hemorrhage (OR 0.36), poor tumor differentiation grade (OR 0.62), and annual center volume of <40 pancreatoduodenectomies (OR 0.51). CONCLUSIONS: This study demonstrated that a third of patients do not receive chemotherapy after resection of PDAC. Next to higher age, worse performance status and lower annual surgical volume, this is mostly related to surgical complications, especially postoperative pancreatic fistula and post-pancreatectomy hemorrhage.
BACKGROUND: The relation between type of postoperative complication and not receiving chemotherapy after resection of pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim was to investigate which patient factors and postoperative complications were associated with not receiving adjuvant chemotherapy. METHODS:Patients who underwent resection (2014-2017) for PDAC were identified from the nationwide mandatory Dutch Pancreatic Cancer Audit. The association between patient-, tumor-, center-, treatment characteristics, and the risk of not receiving adjuvant chemotherapy was analyzed with multivariable logistic regression. RESULTS: Overall, of 1306 patients, 24% (n = 312) developed postoperative Clavien Dindo ≥3 complications. In-hospital mortality was 3.5% (n = 46). Some 433 patients (33%) did not receive adjuvant chemotherapy. Independent predictors (all p < 0.050) for not receiving adjuvant chemotherapy were older age (odds ratio (OR) 0.96), higher ECOG performance status (OR 0.57), postoperative complications (OR 0.32), especially grade B/C pancreatic fistula (OR 0.51) and post-pancreatectomy hemorrhage (OR 0.36), poor tumor differentiation grade (OR 0.62), and annual center volume of <40 pancreatoduodenectomies (OR 0.51). CONCLUSIONS: This study demonstrated that a third of patients do not receive chemotherapy after resection of PDAC. Next to higher age, worse performance status and lower annual surgical volume, this is mostly related to surgical complications, especially postoperative pancreatic fistula and post-pancreatectomy hemorrhage.
Authors: F Jasmijn Smits; Anne Claire Henry; Casper H van Eijck; Marc G Besselink; Olivier R Busch; Mark Arntz; Thomas L Bollen; Otto M van Delden; Daniel van den Heuvel; Christiaan van der Leij; Krijn P van Lienden; Adriaan Moelker; Bert A Bonsing; Inne H M Borel Rinkes; Koop Bosscha; R M van Dam; Sebastiaan Festen; B Groot Koerkamp; Erwin van der Harst; Ignace H de Hingh; Geert Kazemier; Mike Liem; B Marion van der Kolk; Vincent E de Meijer; Gijs A Patijn; Daphne Roos; Jennifer M Schreinemakers; Fennie Wit; C Henri van Werkhoven; I Quintus Molenaar; Hjalmar C van Santvoort Journal: Trials Date: 2020-05-07 Impact factor: 2.279
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