Renato Micelli Lupinacci1, Matthieu Faron2, Philippe Bachellier3, Alain Sauvanet4, Alain Beauchet5, Yves-Patrice Le Treut6, Mustapha Adham7, Jean-Yves Mabrut8, Jean-Robert Delpero9, François Paye10. 1. Department of Digestive and Oncologic Surgery, Hôpital Ambroise Paré-APHP, Université Paris Saclay, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France. rmlupinacci@gmail.com. 2. Department of Surgery, Institut Gustave Roussy, Villejuif, France. 3. Department of Surgery, Hôpital Hautepierre, Université de Strasbourg, Strasbourg, France. 4. Department of Surgery, Hôpital Beaujon, Université Paris VII, Clichy, France. 5. Department of Public Health, Hôpital Ambroise Paré-APHP, Université Paris Saclay, Boulogne-Billancourt, France. 6. Department of Surgery, Hôpital de La Conception, Université de La Méditerranée, Marseille, France. 7. Department of Surgery, Hôpital de La Croix Rousse, Université Claude Bernard Lyon-I, Lyon, France. 8. Department of Surgery, Hôpital Edouard Herriot, Université Claude Bernard Lyon-I, Lyon, France. 9. Department of Surgical Oncology, Institut Paoli-Calmettes, Université de La Méditerranée, Marseille, France. 10. Department of Surgery, Hôpital Saint Antoine, Université Paris VI, Paris, France.
Abstract
BACKGROUND: Acute pancreatitis (AP) can be one of the earliest clinical presentation of pancreatic ductal adenocarcinoma (PDAC). Information about the impact of AP on postoperative outcomes as well as its influences on PDAC survival is scarce. This study aimed to determine whether AP as initial clinical presentation of PDAC impact the short- and long-term outcomes of curative intent pancreatic resection. PATIENTS AND METHODS: From 2004 to 2009, 1449 patients with PDAC underwent pancreatic resection in 37 institutions (France, Belgium and Switzerland). We used univariate and multivariate analysis to identify factors associated with severe complications and pancreatic fistula as well as overall and disease-free survivals. RESULTS: There were 764 males (52,7%), and the median age was 64 years. A total of 781 patients (53.9%) developed at least one complication, among whom 317 (21.8%) were classified as Clavien-Dindo ≥ 3. A total of 114 (8.5%) patients had AP as the initial clinical manifestation of PDAC. This situation was not associated with any increase in the rates of postoperative fistula (21.2% vs 16.4%, P = 0.19), postoperative complications (57% vs 54.2%, P = 0.56), and 30 day mortality (2.6% vs 3.4%, P = 1). In multivariate analysis, AP did not correlate with postoperative complications or pancreatic fistula. The median length of follow-up was 22.4 months. The median overall survival after surgery was 29.9 months in the AP group and 30.5 months in the control group. Overall recurrence rate and local recurrence rate did not differ between groups. CONCLUSION: AP before PDAC resection did not impact postoperative morbidity and mortality, as well as recurrence rate and survival.
BACKGROUND: Acute pancreatitis (AP) can be one of the earliest clinical presentation of pancreatic ductal adenocarcinoma (PDAC). Information about the impact of AP on postoperative outcomes as well as its influences on PDAC survival is scarce. This study aimed to determine whether AP as initial clinical presentation of PDAC impact the short- and long-term outcomes of curative intent pancreatic resection. PATIENTS AND METHODS: From 2004 to 2009, 1449 patients with PDAC underwent pancreatic resection in 37 institutions (France, Belgium and Switzerland). We used univariate and multivariate analysis to identify factors associated with severe complications and pancreatic fistula as well as overall and disease-free survivals. RESULTS: There were 764 males (52,7%), and the median age was 64 years. A total of 781 patients (53.9%) developed at least one complication, among whom 317 (21.8%) were classified as Clavien-Dindo ≥ 3. A total of 114 (8.5%) patients had AP as the initial clinical manifestation of PDAC. This situation was not associated with any increase in the rates of postoperative fistula (21.2% vs 16.4%, P = 0.19), postoperative complications (57% vs 54.2%, P = 0.56), and 30 day mortality (2.6% vs 3.4%, P = 1). In multivariate analysis, AP did not correlate with postoperative complications or pancreatic fistula. The median length of follow-up was 22.4 months. The median overall survival after surgery was 29.9 months in the AP group and 30.5 months in the control group. Overall recurrence rate and local recurrence rate did not differ between groups. CONCLUSION: AP before PDAC resection did not impact postoperative morbidity and mortality, as well as recurrence rate and survival.
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