Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

Krist Aploks; Minha Kim; Stephanie Stroever; Alexander Ostapenko; Young Bo Sim; Ashwinkumar Sooriyakumar; Arash Rahimi-Ardabily; Ramanathan Seshadri; Xiang Da Dong

doi:10.4240/wjgs.v15.i8.1663

Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

World J Gastrointest Surg. 2023 Aug 27;15(8):1663-1672. doi: 10.4240/wjgs.v15.i8.1663.

Authors

Krist Aploks¹, Minha Kim¹, Stephanie Stroever², Alexander Ostapenko¹, Young Bo Sim¹, Ashwinkumar Sooriyakumar¹, Arash Rahimi-Ardabily¹, Ramanathan Seshadri³, Xiang Da Dong⁴

Affiliations

¹ Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States.
² Department of Research and Innovation, Nuvance Health, Danbury, CT 06810, United States.
³ Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, Danbury, CT 06810, United States.
⁴ Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, Danbury, CT 06810, United States. eric.dong@nuvancehealth.org.

Abstract

Background: Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States. In patients with "borderline resectable" disease, current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy. Although neoadjuvant radiotherapy may improve negative margin resection rate, it is theorized that its administration increases operative times and complexity.

Aim: To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.

Methods: Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set, who received a pancreaticoduodenectomy for pancreatic adenocarcinoma, were divided into two groups based off neoadjuvant radiotherapy status. Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy, perioperative blood transfusion status, total operative time, and other perioperative outcomes.

Results: Of the 11458 patients included in the study, 1470 (12.8%) underwent neoadjuvant radiotherapy. Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion [adjusted odds ratio (aOR) = 1.58, 95% confidence interval (CI): 1.37-1.82; P < 0.001] and have longer surgeries (insulin receptor-related receptor = 1.14, 95%CI: 1.11-1.16; P < 0.001), while simultaneously having lower rates of organ space infections (aOR = 0.80, 95%CI: 0.66-0.97; P = 0.02) and pancreatic fistula formation (aOR = 0.50, 95%CI: 0.40-0.63; P < 0.001) compared to those who underwent surgery alone.

Conclusion: Neoadjuvant radiotherapy, while not associated with increased mortality, will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.

Keywords: National Surgery Quality Improvement Program; Neoadjuvant chemoradiation; Operative time; Pancreatic adenocarcinoma; Pancreaticoduodenectomy; Whipple procedure.