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Surgery Today
Published in: Surgery Today 5/2017

01-05-2017 | Original Article

Effect of postoperative major complications on prognosis after pancreatectomy for pancreatic cancer: a retrospective review

Authors: Yusuke Watanabe, Kazuyoshi Nishihara, Sokichi Matsumoto, Takafumi Okayama, Yuji Abe, Toru Nakano

Published in: Surgery Today | Issue 5/2017

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Abstract

Purpose

To investigate the impact of postoperative complications on survival after curative resection for pancreatic cancer.

Methods

We reviewed retrospectively the medical records of 122 patients who underwent curative R0 resection for pancreatic cancer. Major complications included pancreatic fistula and hemorrhage of grade B or C according to the International Study Group of Pancreatic Fistula or Surgery criteria, and other complications of grade ≥III according to the Clavien–Dindo classification.

Results

Thirty-eight patients (31 %) suffered major postoperative complications and 40 patients (33 %) suffered minor complications only. Univariate survival analysis showed that patients with major complications had a significantly worse prognosis than those without major complications, with regard to recurrence-free survival (RFS) (P < 0.01) and overall survival (OS) (P < 0.01), whereas minor complications did not affect survival. Major complications significantly inhibited or delayed adjuvant chemotherapy. Multivariate survival analysis showed that the absence of postoperative major complications was an independent favorable factor for RFS (hazard ratio 0.48; 95 % confidence interval: 0.28–0.85) and OS (hazard ratio 0.47; 95 % confidence interval 0.27–0.81).

Conclusions

Postoperative major complications after pancreatectomy for pancreatic cancer affect the prognosis.
Literature
1.
2.
Helm JF, Centeno BA, Coppola D, Druta M, Park JY, Chen DT, et al. Outcomes following resection of pancreatic adenocarcinoma: 20-year experience at a single institution. Cancer Control. 2008;15:288–94.PubMed
3.
Shimada K, Sakamoto Y, Nara S, Esaki M, Kosuge T, Hiraoka N. Analysis of 5-year survivals after a macroscopic curative pancreatectomy for invasive ductal adenocarcinoma. World J Surg. 2010;34:1908–15.CrossRefPubMed
4.
Asari S, Matsumoto I, Toyama H, Shinzeki M, Goto T, Ishida J, et al. Preoperative independent prognostic factors in patients with borderline resectable pancreatic ductal adenocarcinoma following curative resection: the neutrophil-lymphocyte and platelet-lymphocyte ratios. Surg Today. 2016;46:583–92.CrossRefPubMed
5.
Mizuguchi T, Torigoe T, Satomi F, Shima H, Kutomi G, Ota S, et al. Trials of vaccines for pancreatic ductal adenocarcinoma: is there any hope of an improved prognosis? Surg Today. 2016;46:139–48.CrossRefPubMed
6.
Ferrone CR, Brennan MF, Gonen M, Coit DG, Fong Y, Chung S, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008;12:701–6.CrossRefPubMed
7.
Dusch N, Weiss C, Strobel P, Kienle P, Post S, Niedergethmann M. Factors predicting long-term survival following pancreatic resection for ductal adenocarcinoma of the pancreas. J Gastrointest Surg. 2014;18:674–81.CrossRefPubMed
8.
Nathan H, Wolfgang CL, Edil BH, Choti MA, Herman JM, Schulick RD, et al. Peri-operative mortality and long-term survival after total pancreatectomy for pancreatic adenocarcinoma: a population-based perspective. J Surg Oncol. 2009;99:87–92.CrossRefPubMed
9.
Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.CrossRefPubMedPubMedCentral
10.
Cleary SP, Gryfe R, Guindi M, Creig P, Smith L, Mackenzie R, et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. Am Coll Surg. 2004;198:722–31.CrossRef
11.
Han SS, Jang JK, Kim SW, Kim WH, Lee KU, Park YH. Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas. 2006;32:271–5.CrossRefPubMed
12.
Kimura K, Amano R, Nakata B, Yamazoe S, Hirata K, Murata A, et al. Clinical and pathological features of five-year survivors after pancreatectomy for pancreatic adenocarcinoma. World J Surg Oncol. 2014;12:360.CrossRefPubMedPubMedCentral
13.
Waraya M, Yamashita K, Katagiri H, Ishii K, Takahashi Y, Furuta K, et al. Preoperative serum CA19-9 and dissected pancreatic tissue margin as determiners of long-term survival in pancreatic cancer. Ann Surg Oncol. 2009;16:1231–40.CrossRefPubMed
14.
Hallemeier CL, Botros M, Corsini MM, Haddock MG, Gunderson LL, Miller RC. Preoperative CA 19-9 level is an important prognostic factor in patients with pancreatic adenocarcinoma treated with surgical resection and adjuvant concurrent chemotherapy. Am J Clin Oncol. 2011;34:567–72.CrossRefPubMed
15.
Zacharias T, Jaeck D, Oussoultzoglou E, Neuville A, Bachenllier P. Impact of lymph node involvement on long-term survival after R0 pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas. J Gartointest Surg. 2007;11:350–6.CrossRef
16.
Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237:74–85.CrossRefPubMedPubMedCentral
17.
Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–62.CrossRefPubMed
18.
Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann Surg. 1995;221:721–31.CrossRefPubMedPubMedCentral
19.
Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg. 2011;254:311–9.CrossRefPubMed
20.
Lerut T, Moons J, Coosemans W, Van Raemdonck D, De leyn P, Decaluwe H, et al. Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg. 2009;92:1103–9.
21.
Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:1575–83.CrossRefPubMed
22.
Laurent C, Sa Cunha A, Couderc P, Rullier E, Saric J. Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg. 2003;90:1131–6.CrossRefPubMed
23.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPS) definition. Surgery. 2005;138:8–13.CrossRefPubMed
24.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery. 2007;142:20–5.CrossRefPubMed
25.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.CrossRefPubMed
26.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMed
27.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan clinical oncology group postoperative complications criteria. Surg Today. 2016;46:668–85.CrossRefPubMed
28.
Bosman FT, Carneiro F, Hruban Theise ND. World health organization of tumors of the digestive system. 4th ed. Lyon: IARC Press; 2010.
29.
Sobin L, Gospodarowics M, Wittekind C. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2009.
30.
Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.CrossRefPubMed
31.
Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.CrossRefPubMed
32.
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.CrossRefPubMed
33.
Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305:2335–42.CrossRefPubMed
34.
Murakami Y, Uemura K, Sudo T, Hashimoto Y, Kondo N, Nakagawa N, et al. Early initiation of adjuvant chemotherapy improves survival of patients with pancreatic carcinoma after surgical resection. Cancer Chemother Pharmacol. 2013;71:419–29.CrossRefPubMed
35.
Valle JW, Palmer D, Jackson R, Cox T, Neoptolemos JP, Ghaneh P, et al. Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study. J Clin Oncol. 2014;32:504–12.CrossRefPubMed
36.
Kawai M, Murakami Y, Motoi F, Sho M, Satoi S, Matsumoto I, et al. Grade B pancreatic fistulas do not affect survival after pancreatectomy for pancreatic cancer: a multicenter observational study. Surgery. 2016;. doi:10.​1016/​j.​surg.​2016.​02.​032.
37.
Goldfarb Y, Sorski L, Benish M, Levi B, Melamed R, Ben-Eliyahu S. Improving postoperative immune status and resistance to cancer metastasis: a combined perioperative approach of immunostimulation and prevention of excessive surgical stress responses. Ann Surg. 2011;253:798–810.CrossRefPubMed
38.
39.
Watanabe Y, Ohtsuka T, Kimura H, Matsunaga T, Tamura K, Ideno N, et al. Braun enteroenterostomy reduces delayed gastric emptying after pylorus-preserving pancreatoduodenectomy: a retrospective review. Am J Surg. 2015;209:369–77.CrossRefPubMed
40.
Kamphues C, Bova R, Schricke D, Hippler-Benscheidt M, Klauschen F, Stenzinger A, et al. Postoperative complications deteriorate long-term outcome in pancreatic cancer patients. Ann Surg Oncol. 2012;19:856–63.CrossRefPubMed
41.
Petermann D, Demartines N, Schafer M. Severe postoperative complications adversely affect long-term survival after R1 resection for pancreatic head carcinoma. World J Surg. 2013;37:1901–8.CrossRefPubMed
42.
Aoyama T, Murakawa M, Katayama Y, Yamaoku K, Kanazawa A, Higuchi A, et al. Impact of postoperative complications on survival and recurrence in pancreatic cancer. Anticancer Res. 2015;35:2401–10.PubMed
43.
Tjaden C, Hinz U, Hassenpflug M, Fritz F, Fritz S, Grenacher L, et al. Fluid collection after distal pancreatectomy: a frequent finding. HPB Oxf. 2016;18:35–40.CrossRef
44.
Watanabe Y, Ohtsuka T, Matsunaga T, Kimura H, Tamura K, Ideno N, et al. Long-term outcomes after total pancreatectomy: special reference to survivors’ living conditions and quality of life. World J Surg. 2015;39:1231–9.CrossRefPubMed
Metadata
Title
Effect of postoperative major complications on prognosis after pancreatectomy for pancreatic cancer: a retrospective review
Authors
Yusuke Watanabe
Kazuyoshi Nishihara
Sokichi Matsumoto
Takafumi Okayama
Yuji Abe
Toru Nakano
Publication date
01-05-2017
Publisher
Springer Japan
Published in
Surgery Today / Issue 5/2017
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-016-1426-1

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