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01-02-2015 | Original Scientific Report

Is Pancreatic Fistula Associated with Worse Overall Survival in Patients with Pancreatic Carcinoma?

Authors: Yoshiaki Murakami, Kenichiro Uemura, Takeshi Sudo, Yasushi Hashimoto, Naru Kondo, Naoya Nakagawa, Hayato Sasaki, Taijiro Sueda

Published in: World Journal of Surgery | Issue 2/2015

Abstract

Background

Pancreatic fistula (PF) is one of the leading complications after pancreatic resection for pancreatic carcinoma. The aim of this study was to determine whether PF was associated with deterioration of long-term outcomes in patients with pancreatic carcinoma after surgical resection.

Methods

Medical records of 210 patients with pancreatic carcinoma who underwent tumor resection were reviewed retrospectively. PF was defined as grade B or C PF according to the criteria of the International Study Group on Pancreatic Fistula. Clinicopathological factors including overall survival were compared between patients with and without PF by univariate and multivariate analyses.

Results

Thirty-one patients (15 %) developed postoperative PF, and 179 (85 %) did not. The 31 cases of PF consisted of 27 grade B PF and 4 grade C PF. There were no differences in the use of adjuvant chemotherapy, tumor differentiation, lymph node status, surgical margin status, or UICC stage between groups. Overall 5-year survival rates for patients with and without PF were 25 and 27 %, respectively. There was no significant difference in overall survival between the two groups (P = 0.743). Multivariate analysis demonstrated that the use of postoperative adjuvant chemotherapy (P < 0.001), tumor differentiation (P = 0.005), and lymph node metastasis (p < 0.001) were factors independently associated with overall survival.

Conclusions

These results suggested that PF was not associated with deterioration of long-term outcomes in patients with pancreatic carcinoma. However, further analyses on larger number of patients are needed to determine a negative effect of grade C PF on long-term survival.

Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29PubMedCrossRef

Bassi C, Dervenis C, Butturini G, International Study Group on Pancreatic Fistula Definition et al (2005) Postoperative pancreatic fistula: an International Study Group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef

Pratt WB, Maithel SK, Vanounou T et al (2007) Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg 245:443–451PubMedCentralPubMedCrossRef

Reid-Lombardo KM, Farnell MB, Crippa S, Pancreatic Anastomotic Leak Study Group et al (2007) Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg 11:1451–1458PubMedCrossRef

Fuks D, Piessen G, Huet E et al (2009) Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg 197:702–709PubMedCrossRef

Kawai M, Tani M, Hirono S et al (2009) How do we predict the clinically relevant pancreatic fistula after pancreaticoduodenectomy? an analysis in 244 consecutive patients. World J Surg 33:2670–2678. doi:10.1007/s00268-009-0220-2 PubMedCrossRef

Gebauer F, Kloth K, Tachezy M et al (2012) Options and limitations in applying the fistula classification by the International Study Group for Pancreatic Fistula. Ann Surg 256:130–138PubMedCrossRef

Sudo T, Murakami Y, Uemura K et al (2011) Distal pancreatectomy with duct-to-mucosa pancreaticogastrostomy: a novel technique for preventing postoperative pancreatic fistula. Am J Surg 202:77–81PubMedCrossRef

Diener MK, Seiler CM, Rossion I et al (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377:1514–1522PubMedCrossRef

10.

Frozanpor F, Lundell L, Segersvärd R et al (2012) The effect of prophylactic transpapillary pancreatic stent insertion on clinically significant leak rate following distal pancreatectomy: results of a prospective controlled clinical trial. Ann Surg 255:1032–1036PubMedCrossRef

11.

Hassenpflug M, Hartwig W, Strobel O et al (2012) Decrease in clinically relevant pancreatic fistula by coverage of the pancreatic remnant after distal pancreatectomy. Surgery 152:S164–S171PubMedCrossRef

12.

Montorsi M, Zerbi A, Bassi C, Italian Tachosil Study Group et al (2012) Efficacy of an absorbable fibrin sealant patch (TachoSil) after distal pancreatectomy: a multicenter, randomized, controlled trial. Ann Surg 256:853–859PubMedCrossRef

13.

McArdle CS, McMillan DC, Hole DJ (2005) Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 92:1150–1154PubMedCrossRef

14.

den Dulk M, Marijnen CA, Collette L et al (2009) Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 96:1066–1075CrossRef

15.

Sierzega M, Kolodziejczyk P, Kulig J, Polish Gastric Cancer Study Group (2010) Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 97:1035–1042PubMedCrossRef

16.

Rizk NP, Bach PB, Schrag D et al (2004) The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 198:42–50PubMedCrossRef

17.

Nagai S, Fujii T, Kodera Y et al (2011) Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol 18:2329–2337PubMedCrossRef

18.

Ausania F, Cook N, Jamieson N et al (2010) Impact of pancreatic leaks on survival following pancreaticoduodenectomy. JOP 11:226–229PubMed

19.

Murakami Y, Uemura K, Ohge H et al (2006) Intraductal papillary-mucinous neoplasms and mucinous cystic neoplasms of the pancreas differentiated by ovarian-type stroma. Surgery 140:443–453CrossRef

20.

Murakami Y, Uemura K, Sudo T et al (2010) Prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma. World J Surg 34:1900–1907. doi:10.1007/s00268-010-0577-2 PubMedCrossRef

21.

Hirano S, Kondo S, Hara T et al (2007) Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: long-term results. Ann Surg 246:46–51PubMedCentralPubMedCrossRef

22.

Murakami Y, Uemura K, Sudo T et al (2013) Benefit of portal or superior mesenteric vein resection with adjuvant chemotherapy for patients with pancreatic head carcinoma. J Surg Oncol 107:414–421PubMedCrossRef

23.

Murakami Y, Uemura K, Hayashidani Y et al (2008) No mortality after 150 consecutive pancreatoduodenctomies with duct-to-mucosa pancreaticogastrostomy. J Surg Oncol 97:205–209PubMedCrossRef

24.

Sobin LH, Gospodarowicz MK, Wittekind C (eds) (2010) Internatinal Union Against Cancer (UICC): TNM classification of malignant tumours, 7th edn. Wiley, New York

25.

Murakami Y, Uemura K, Sudo T et al (2008) Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg 195:757–762PubMedCrossRef

26.

Murakami Y, Uemura K, Sudo T et al (2009) Impact of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for adenocarcinoma of the body or tail of the pancreas. J Gastrointest Surg 13:85–92PubMedCrossRef

27.

Murakami Y, Uemura K, Sudo T et al (2012) Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol 106:174–180PubMedCrossRef

28.

Raut CP, Tseng JF, Sun CC et al (2007) Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 246:52–60PubMedCentralPubMedCrossRef

29.

Kang CM, Kim DH, Choi GH et al (2009) Detrimental effect of postoperative complications on oncologic efficacy of R0 pancreatectomy in ductal adenocarcinoma of the pancreas. J Gastrointest Surg 13:907–914PubMedCrossRef

30.

Kamphues C, Bova R, Schricke D et al (2012) Postoperative complications deteriorate long-term outcome in pancreatic cancer patients. Ann Surg Oncol 19:856–863PubMedCrossRef

31.

Crumley AB, Going JJ, Hilmy M et al (2011) Interrelationships between tumor proliferative activity, leucocyte and macrophage infiltration, systemic inflammatory response, and survival in patients selected for potentially curative resection for gastroesophageal cancer. Ann Surg Oncol 18:2604–2612PubMedCrossRef

32.

Roxburgh CS, Platt JJ, Leitch EF et al (2011) Relationship between preoperative comorbidity, systemic inflammatory response, and survival in patients undergoing curative resection for colorectal cancer. Ann Surg Oncol 18:997–1005PubMedCrossRef

33.

Richards CH, Leitch EF, Horgan PG et al (2010) The relationship between patient physiology, the systemic inflammatory response and survival in patients undergoing curative resection of colorectal cancer. Br J Cancer 103:1356–1361PubMedCentralPubMedCrossRef

34.

Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297:267–277PubMedCrossRef

35.

Neoptolemos JP, Stocken DD, Bassi C et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine followed pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081PubMedCrossRef

36.

Biagi JJ, Raphael MJ, Mackillop WJ et al (2011) Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA 305:2335–2342PubMedCrossRef

37.

Des Guetz G, Nicolas P, Perret GY et al (2010) Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer 46:1049–1055PubMedCrossRef

38.

Lohrisch C, Paltiel C, Gelmon K et al (2006) Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 24:4888–4894PubMedCrossRef

39.

Colleoni M, Bonetti M, Coates AS et al (2000) Early start of adjuvant chemotherapy may improve treatment outcome for premenopausal breast cancer patients with tumors not expressing estrogen receptors. The International Breast Cancer Study Group. J Clin Oncol 18:584–590PubMed

40.

Murakami Y, Uemura K, Sudo T et al (2013) Early initiation of adjuvant chemotherapy improves survival of patients with pancreatic carcinoma after surgical resection. Cancer Chemother Pharmacol 71:419–429PubMedCrossRef

Title: Is Pancreatic Fistula Associated with Worse Overall Survival in Patients with Pancreatic Carcinoma?
Authors: Yoshiaki Murakami
Kenichiro Uemura
Takeshi Sudo
Yasushi Hashimoto
Naru Kondo
Naoya Nakagawa
Hayato Sasaki
Taijiro Sueda
Publication date: 01-02-2015
Publisher: Springer US
Published in: World Journal of Surgery / Issue 2/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2823-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is Pancreatic Fistula Associated with Worse Overall Survival in Patients with Pancreatic Carcinoma?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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