Einzeltreffer — DigiBib

Background: Postoperative pancreatic fistula remains the leading cause of significant morbidity after pancreatoduodenectomy for pancreatic ductal adenocarcinoma. Preoperative chemoradiotherapy has been described to reduce the risk of postoperative pancreatic fistula, but randomized trials on neoadjuvant treatment in pancreatic ductal adenocarcinoma focus increasingly on preoperative chemotherapy rather than preoperative chemoradiotherapy. This study aimed to investigate the impact of preoperative chemotherapy and preoperative chemoradiotherapy on postoperative pancreatic fistula and other pancreatic-specific surgery related complications on a nationwide level.

Methods: All patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma were included in the mandatory nationwide prospective Dutch Pancreatic Cancer Audit (2014-2020). Baseline and treatment characteristics were compared between immediate surgery, preoperative chemotherapy, and preoperative chemoradiotherapy. The relationship between preoperative chemotherapy, chemoradiotherapy, and clinically relevant postoperative pancreatic fistula (International Study Group of Pancreatic Surgery grade B/C) was investigated using multivariable logistic regression analyses.

Results: Overall, 2,019 patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma were included, of whom 1,678 underwent immediate surgery (83.1%), 192 (9.5%) received preoperative chemotherapy, and 149 (7.4%) received preoperative chemoradiotherapy. Postoperative pancreatic fistula occurred in 8.3% of patients after immediate surgery, 4.2% after preoperative chemotherapy, and 2.0% after preoperative chemoradiotherapy (P = .004). In multivariable analysis, the use of preoperative chemoradiotherapy was associated with reduced risk of postoperative pancreatic fistula (odds ratio, 0.21; 95% confidence interval, 0.03-0.69; P = .033) compared with immediate surgery, whereas preoperative chemotherapy was not (odds ratio, 0.59; 95% confidence interval, 0.25-1.25; P = .199). Intraoperatively hard, or fibrotic pancreatic texture was most frequently observed after preoperative chemoradiotherapy (53% immediate surgery, 62% preoperative chemotherapy, 77% preoperative chemoradiotherapy, P < .001).

Conclusion: This nationwide analysis demonstrated that in patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma, only preoperative chemoradiotherapy, but not preoperative chemotherapy, was associated with a reduced risk of postoperative pancreatic fistula.

Titel:	Preoperative chemoradiotherapy but not chemotherapy is associated with reduced risk of postoperative pancreatic fistula after pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a nationwide analysis.
Autor/in / Beteiligte Person:	Wismans, LV ; Suurmeijer, JA ; van Dongen JC ; Bonsing, BA ; Van Santvoort, HC ; Wilmink, JW ; van Tienhoven G ; de Hingh IH ; Lips, DJ ; van der Harst E ; de Meijer VE ; Patijn, GA ; Bosscha, K ; Stommel, MW ; Festen, S ; den Dulk M ; Nuyttens, JJ ; Intven, MPW ; de Vos-Geelen J ; Molenaar, IQ ; Busch, OR ; Koerkamp, BG ; Besselink, MG ; van Eijck CHJ
Zeitschrift:	Surgery, Jg. 175 (2024-06-01), Heft 6, S. 1580-1586
Veröffentlichung:	St. Louis, MO : Mosby ; <i>Original Publication</i>: St. Louis., 2024
Medientyp:	academicJournal
ISSN:	1532-7361 (electronic)
DOI:	10.1016/j.surg.2024.01.029
Schlagwort:	Humans Female Male Middle Aged Aged Netherlands epidemiology Neoadjuvant Therapy methods Neoadjuvant Therapy adverse effects Chemoradiotherapy adverse effects Chemoradiotherapy methods Prospective Studies Preoperative Care methods Pancreaticoduodenectomy adverse effects Pancreatic Fistula prevention & control Pancreatic Fistula etiology Pancreatic Fistula epidemiology Carcinoma, Pancreatic Ductal therapy Carcinoma, Pancreatic Ductal surgery Pancreatic Neoplasms therapy Pancreatic Neoplasms surgery Postoperative Complications prevention & control Postoperative Complications epidemiology Postoperative Complications etiology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Corporate Authors: Dutch Pancreatic Cancer Group Publication Type: Journal Article Language: English [Surgery] 2024 Jun; Vol. 175 (6), pp. 1580-1586. <i>Date of Electronic Publication: </i>2024 Mar 05. MeSH Terms: Pancreaticoduodenectomy* / adverse effects ; Pancreatic Fistula* / prevention & control ; Pancreatic Fistula* / etiology ; Pancreatic Fistula* / epidemiology ; Carcinoma, Pancreatic Ductal* / therapy ; Carcinoma, Pancreatic Ductal* / surgery ; Pancreatic Neoplasms* / therapy ; Pancreatic Neoplasms* / surgery ; Postoperative Complications* / prevention & control ; Postoperative Complications* / epidemiology ; Postoperative Complications* / etiology ; Humans ; Female ; Male ; Middle Aged ; Aged ; Netherlands / epidemiology ; Neoadjuvant Therapy / methods ; Neoadjuvant Therapy / adverse effects ; Chemoradiotherapy / adverse effects ; Chemoradiotherapy / methods ; Prospective Studies ; Preoperative Care / methods Entry Date(s): Date Created: 20240306 Date Completed: 20240509 Latest Revision: 20240509 Update Code: 20240510

Klicken Sie ein Format an und speichern Sie dann die Daten oder geben Sie eine Empfänger-Adresse ein und lassen Sie sich per Email zusenden.

BibTeX Citavi, JabRef, u.a.
(Literaturverwaltung)

PDF kein Volltext!
(Merkzettel, Notizen)

RIS Endnote, Citavi u.a.
(Literaturverwaltung)

MODS
(XML zur Weiterverarbeitung)

oder

Wählen Sie das für Sie passende Zitationsformat und kopieren Sie es dann in die Zwischenablage, lassen es sich per Mail zusenden oder speichern es als PDF-Datei.

Gewünschter Zitations-Stil:

oder

Bitte prüfen Sie, ob die Zitation formal korrekt ist, bevor Sie sie in einer Arbeit verwenden. Benutzen Sie gegebenenfalls den "Exportieren"-Dialog, wenn Sie ein Literaturverwaltungsprogramm verwenden und die Zitat-Angaben selbst formatieren wollen.

Preoperative chemoradiotherapy but not chemotherapy is associated with reduced risk of postoperative pancreatic fistula after pancreatoduodenectomy for pancreatic ductal adenocarcinoma: a nationwide analysis.