Jillian W Bonaroti1, Mazen S Zenati1, Amr I Al-Abbas1, Caroline J Rieser1, Amer H Zureikat1, Melissa E Hogg2, Herbert J Zeh3, Brian A Boone4. 1. Department of Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Hospital F1281, 200 Lothrop Street, Pittsburgh, PA, 15213, USA. 2. Department of Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Hospital F1281, 200 Lothrop Street, Pittsburgh, PA, 15213, USA; Department of Surgery, Northshore University Health System, 2650 Ridge Ave, Room 2539 Walgreen Building, Evanston, IL, 60201, USA. 3. Department of Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Hospital F1281, 200 Lothrop Street, Pittsburgh, PA, 15213, USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Office E.7102B, Dallas, TX, 75390, USA. 4. Department of Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Hospital F1281, 200 Lothrop Street, Pittsburgh, PA, 15213, USA; Department of Surgery, West Virginia University, PO Box 9238 Health Sciences Center, One Medical Center Drive, Morgantown, WV, 26506, USA. Electronic address: brian.boone@hsc.wvu.edu.
Abstract
BACKGROUND: The short-term morbidity associated with post-operative pancreatic fistula (POPF) is well established, however data regarding the long-term impact are lacking. We aim to characterize long-term oncologic outcomes of POPF after pancreatic resection through a single institution, retrospective study of pancreatic resections performed for adenocarcinoma from 2009 to 2016. METHODS: Kaplan-Meier survival analysis, logistic regression, and multivariate analysis (MVA) were used to evaluate impact of POPF on overall survival (OS), disease free survival (DFS), and receipt of adjuvant chemotherapy (AC). RESULTS: 767 patients were included. 82 (10.6%) developed grade B (n = 67) or C (n = 15) POPF. Grade C POPF resulted in decreased OS when compared to no POPF (20.22 vs 26.33 months, p = 0.027) and to grade B POPF (20.22 vs. 26.87 months, p = 0.049). POPF patients were less likely to receive AC than those without POPF (59.5% vs 74.9%, p = 0.003) and grade C POPF were less likely to receive AC than all others (26.7% vs 74.2%, p = 0.0001). CONCLUSION: POPF patients are less likely to receive AC and more likely to have delay in time to AC. These factors are exacerbated in grade C POPF and likely contribute to decreased OS. These findings validate the clinical significance of the ISGPF definition of POPF.
BACKGROUND: The short-term morbidity associated with post-operative pancreatic fistula (POPF) is well established, however data regarding the long-term impact are lacking. We aim to characterize long-term oncologic outcomes of POPF after pancreatic resection through a single institution, retrospective study of pancreatic resections performed for adenocarcinoma from 2009 to 2016. METHODS: Kaplan-Meier survival analysis, logistic regression, and multivariate analysis (MVA) were used to evaluate impact of POPF on overall survival (OS), disease free survival (DFS), and receipt of adjuvant chemotherapy (AC). RESULTS: 767 patients were included. 82 (10.6%) developed grade B (n = 67) or C (n = 15) POPF. Grade C POPF resulted in decreased OS when compared to no POPF (20.22 vs 26.33 months, p = 0.027) and to grade B POPF (20.22 vs. 26.87 months, p = 0.049). POPF patients were less likely to receive AC than those without POPF (59.5% vs 74.9%, p = 0.003) and grade C POPF were less likely to receive AC than all others (26.7% vs 74.2%, p = 0.0001). CONCLUSION: POPF patients are less likely to receive AC and more likely to have delay in time to AC. These factors are exacerbated in grade C POPF and likely contribute to decreased OS. These findings validate the clinical significance of the ISGPF definition of POPF.
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