Piera Leon1, Fabio Giannone2, Giulio Belfiori3, Massimo Falconi3, Stefano Crippa3, Ugo Boggi4, Francesca Menonna4, Abdul Rahman Al Sadairi5, Tullio Piardi5, Laurent Sulpice6, Andrea Gardini7, Valentina Sega8, Mircea Chirica9, Ferruccio Ravazzoni10, Giusy Giannandrea11, Patrick Pessaux12, Vito de Blasi13, Francis Navarro2, Fabrizio Panaro2. 1. Department of Surgery/Division of HBP Surgery and Transplantation, "Saint Eloi" Montpellier University Hospital, Montpellier, France. p-leon@chu-montpellier.fr. 2. Department of Surgery/Division of HBP Surgery and Transplantation, "Saint Eloi" Montpellier University Hospital, Montpellier, France. 3. "San Raffaele" IRCCS Hospital, Università Vita - Salute, Milan, Italy. 4. "Cisanello" University Hospital, Pisa, Italy. 5. Reims University Hospital, Reims, France. 6. Rennes University Hospital, Rennes, France. 7. "G.B. Morgagni-L. Pierantoni" Hospital, Forli, Italy. 8. "Fondazione Poliambulanza" Hospital, Brescia, Italy. 9. "Grenoble Alpes" University Hospital, Grenoble, France. 10. "SS. Antonio e Biagio e Cesare Arrigo" IRCCS Hospital, Alessandria, Italy. 11. "Policlinico" Bari University Hospital, Bari, Italy. 12. IHU Strasbourg University Hospital, Strasbourg, France. 13. Hospital Centre of Luxembourg, Luxembourg City, Luxembourg.
Abstract
OBJECTIVES: The aim of this study was to assess the impact of clinically relevant postoperative pancreatic fistula (CR-POPF) on patient disease-specific survival and recurrence after curative distal pancreatectomy (DP) for pancreatic cancer. DESIGN: This was a retrospective case-control analysis. METHODS: We examined the data of adult patients with a diagnosis of pancreatic ductal adenocarcinoma (PDAC) of the body and tail of the pancreas undergoing curative DP, over a 10-year period in 12 European surgical departments, from a prospectively implemented database. RESULTS: Among the 382 included patients, 283 met the strict inclusion criteria; 139 were males (49.1%) and the median age of the entire population was 70 years (range 37-88). A total of 121 POPFs were observed (42.8%), 42 (14.9%) of which were CR-POPFs. The median follow-up period was 24 months (range 3-120). Although poorer in the POPF group, overall survival (OS) and disease-free survival (DFS) did not differ significantly between patients with and without CR-POPF (p = 0.224 and p = 0.165, respectively). CR-POPF was not significantly associated with local or peritoneal recurrence (p = 0.559 and p = 0.302, respectively). A smaller percentage of patients benefited from adjuvant chemotherapy after POPF (76.2% vs. 83.8%), but the difference was not significant (p = 0.228). CONCLUSIONS: CR-POPF is a major complication after DP but it did not affect the postoperative therapeutic path or long-term oncologic outcomes. CR-POPF was not a predictive factor for disease recurrence and was not associated with an increased incidence of peritoneal or local relapse. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04348084.
OBJECTIVES: The aim of this study was to assess the impact of clinically relevant postoperative pancreatic fistula (CR-POPF) on patient disease-specific survival and recurrence after curative distal pancreatectomy (DP) for pancreatic cancer. DESIGN: This was a retrospective case-control analysis. METHODS: We examined the data of adult patients with a diagnosis of pancreatic ductal adenocarcinoma (PDAC) of the body and tail of the pancreas undergoing curative DP, over a 10-year period in 12 European surgical departments, from a prospectively implemented database. RESULTS: Among the 382 included patients, 283 met the strict inclusion criteria; 139 were males (49.1%) and the median age of the entire population was 70 years (range 37-88). A total of 121 POPFs were observed (42.8%), 42 (14.9%) of which were CR-POPFs. The median follow-up period was 24 months (range 3-120). Although poorer in the POPF group, overall survival (OS) and disease-free survival (DFS) did not differ significantly between patients with and without CR-POPF (p = 0.224 and p = 0.165, respectively). CR-POPF was not significantly associated with local or peritoneal recurrence (p = 0.559 and p = 0.302, respectively). A smaller percentage of patients benefited from adjuvant chemotherapy after POPF (76.2% vs. 83.8%), but the difference was not significant (p = 0.228). CONCLUSIONS: CR-POPF is a major complication after DP but it did not affect the postoperative therapeutic path or long-term oncologic outcomes. CR-POPF was not a predictive factor for disease recurrence and was not associated with an increased incidence of peritoneal or local relapse. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04348084.
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