TY - JOUR
T1 - The risk of not receiving adjuvant chemotherapy after resection of pancreatic ductal adenocarcinoma: a nationwide analysis
AU - Dutch Pancreatic Cancer Group
AU - Mackay, Tara M.
AU - Smits, F. Jasmijn
AU - Roos, Daphne
AU - Bonsing, Bert A.
AU - Bosscha, Koop
AU - Busch, Olivier R.
AU - Creemers, Geert-Jan
AU - van Dam, Ronald M.
AU - van Eijck, Casper H. J.
AU - Gerhards, Michael F.
AU - de Groot, Jan Willem B.
AU - Groot Koerkamp, Bas
AU - Haj Mohammad, Nadia
AU - van der Harst, Erwin
AU - de Hingh, Ignace H. J. T.
AU - Homs, Marjolein Y. V.
AU - Kazemier, Geert
AU - Liem, Mike S. L.
AU - de Meijer, Vincent E.
AU - Molenaar, I. Quintus
AU - Nieuwenhuijs, Vincent B.
AU - van Santvoort, Hjalmar C.
AU - van der Schelling, George P.
AU - Stommel, Martijn W. J.
AU - ten Tije, Albert Jan
AU - de Vos-Geelen, Judith
AU - Wit, Fennie
AU - Wilmink, Johanna W.
AU - van Laarhoven, Hanneke W. M.
AU - Besselink, Marc G.
N1 - Funding Information: The Dutch Pancreatic Cancer Project, including the Dutch Pancreatic Cancer Audit, received funding from the Dutch Cancer Society (KWF Kankerbestrijding; grant no. UVA2013-5842). We thank Elizabeth M. Gleeson, MD, MPH, for proofreading of the manuscript. Funding Information: The Dutch Pancreatic Cancer Project, including the Dutch Pancreatic Cancer Audit, received funding from the Dutch Cancer Society (KWF Kankerbestrijding; grant no. UVA2013-5842 ). Publisher Copyright: © 2019 International Hepato-Pancreato-Biliary Association Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85070760316&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hpb.2019.06.019
DO - https://doi.org/10.1016/j.hpb.2019.06.019
M3 - Article
C2 - 31439478
SN - 1365-182X
VL - 22
SP - 233
EP - 240
JO - HPB
JF - HPB
IS - 2
ER -