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HPB (Oxford). 2019 Aug 19. pii: S1365-182X(19)30610-0. doi: 10.1016/j.hpb.2019.06.019. [Epub ahead of print]

The risk of not receiving adjuvant chemotherapy after resection of pancreatic ductal adenocarcinoma: a nationwide analysis.

Author information

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.

PMID:
31439478
DOI:
10.1016/j.hpb.2019.06.019

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