Prognostic impact of postoperative complication after pancreatoduodenectomy for pancreatic adenocarcinoma stratified by the resectability status.

The aim of this study was to investigate the prognostic impact of postoperative complications after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) stratified by resectability status. Medical records of 226 patients with pancreatic head carcinoma who underwent PD, including 115 with resectable (R) and 111 with borderline resectable/unresectable (BR/UR) PDAC, were reviewed retrospectively. Major complications were defined as grade III or IV based on the Clavien-Dindo classification system. The prognostic impact of major complications on overall survival (OS) was analyzed using univariate and multivariate analyses with stratification by resectability status. A multivariate analysis in the BR/UR group identified R1 resection (P = 0.03), T 3/4 stage (P = 0.03), and incidence of major complications (P = 0.03) as independent risk factors for poor survival, whereas major complications did not affect survival in the R group. Initiation of adjuvant gemcitabine plus S-1 chemotherapy occurred significantly less frequently for patients with major complications than for those without major complications in the BR/UR group (P = 0.02). A negative prognostic impact of postoperative major complications after PD was observed in patients with BR/UR PDAC, whereas the prognostic impact was unclear in patients with R PDAC.

Kondo N ，Murakami Y ，Uemura K ，Nakagawa N ，Okada K ，Takahashi S ，Sueda T ... -  《-》

Reappraisal of the validity of surgery for patients with pancreatic cancer aged 80 years or older stratified by resectability status.

The aim of this study was to assess the validity of surgical resection for patients with pancreatic ductal adenocarcinoma (PDAC) aged ≥80 years stratified by resectability status. Medical records of 245 patients with resectable (R) and 169 with borderline resectable/unresectable (BR/UR) PDAC were reviewed retrospectively. Of the total of 414 patients, 56 (14%) were ≥80 years. The prognostic impact of age ≥80 years was analyzed with stratification by resectability status. No significant difference was found in the incidence of major complications between patients aged ≥80 versus <80 years (12% vs. 16% respectively; P = 0.53). However, patients aged ≥80 years were significantly less likely to receive adjuvant gemcitabine + S-1 chemotherapy than those <80 years (39% vs. 83%, respectively; P < 0.001). Multivariate analyses identified age ≥80 years as an independent risk factor for poor survival in the BR/UR group (P = 0.01), whereas it did not affect survival in the R group. Patients aged ≥80 years had a similar prognosis to <80 years in R PDAC, whereas they had significantly worse prognosis in BR/UR PDAC. These findings suggest that surgical resection for patients with PDAC aged ≥80 years is validated in R PDAC, whereas its survival benefit might be limited in BR/UR PDAC.

Kondo N ，Uemura K ，Nakagawa N ，Okada K ，Seo S ，Takahashi S ，Murakami Y ... -  《-》

Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX.

Michelakos T ，Pergolini I ，Castillo CF ，Honselmann KC ，Cai L ，Deshpande V ，Wo JY ，Ryan DP ，Allen JN ，Blaszkowsky LS ，Clark JW ，Murphy JE ，Nipp RD ，Parikh A ，Qadan M ，Warshaw AL ，Hong TS ，Lillemoe KD ，Ferrone CR ... -  《-》

The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma.

Ruess DA ，Makowiec F ，Chikhladze S ，Sick O ，Riediger H ，Hopt UT ，Wittel UA ... -  《BMC Surgery》

Extended pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery is associated with worse survival but not with increased morbidity.

Recently, the International Study Group for Pancreatic Surgery presented a consensus statement on the definition of an extended pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Because extended resections are associated with increased morbidity and mortality, prognostic factors for outcome are mandatory to optimize patient selection. The aim of this study was to apply the new definition of an extended PD and to assess prognostic factors for short-term complications and survival in patients with PDAC. A retrospective analysis was performed on a prospectively collected database running from 2004 to 2014. Inclusion criteria were all PD resections with histopathology-proven PDAC. Clinical data, operative results, and short- and long-term outcomes were analyzed. We included 177 patients who underwent PD for PDAC in this study. Sixty-six patients (37%) underwent a standard PD and 111 (63%) underwent an extended PD. No differences were found in duration of postoperative stay (median, 13 days) or overall complication rate of 35% (n = 61). Severe complications occurred in 24 patients (13%). Male sex (odds ratio, 2.4; 95% CI, 0.9-6.6) was a prognostic factor for severe complications. There was no in-hospital or 90-day mortality in either group. Multivariate survival analysis showed that poor tumor differentiation (hazard ratio [HR], 2.0; 95% CI, 1.3-3.1), lymph node metastasis (HR, 2.3; 95% CI, 1.4-3.9), neural invasion (HR, 1.9; 95% CI, 1.2-3.1), were independent prognostic factors for worse survival. An extended resection was associated with worse survival, but was not an independent prognostic factor (HR, 1.5; 95% CI, 1.0-2.3). Extended PD is associated with worse survival but not with increased morbidity.

De Reuver PR ，Mittal A ，Neale M ，Gill AJ ，Samra JS ... -  《-》