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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2024

27-12-2023 | Pancreatectomy | Pancreatic Tumors

Neoadjuvant Chemotherapy is Associated with Increased Risk of Postoperative DVT After Distal Pancreatectomy for Pancreatic Adenocarcinoma: a NSQIP Analysis

Authors: Keenan J. Robbins, MBBS, MPHS, Kenneth F. Newcomer Jr., MD, Erica K. Barnell, MD, PhD, Michael A. Anzelmo, BS, Jingxia Liu, MD, PhD, William G. Hawkins, MD, FACS

Published in: Annals of Surgical Oncology | Issue 5/2024

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Abstract

Background

Venous thromboembolism (VTE) remains a persistent source of postoperative morbidity despite prevention and mitigation efforts. Cancer, surgery, and chemotherapy are known risk factors for VTE. Existing literature suggests that neoadjuvant therapy (NAT) may contribute to increased VTE risk in the postoperative period, but few authors specifically examine this relationship in distal pancreatic adenocarcinoma (PDAC). In this study, we analyze the association of NAT and postoperative VTE in patients who underwent distal pancreatectomy (DP) for PDAC.

Patients and Methods

Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, we analyzed the Procedure Targeted files for pancreatectomy from 2014 to 2020. Adults with PDAC who underwent DP were grouped by receipt of NAT. The primary outcome was the rate of deep venous thrombosis (DVT) and the secondary outcome was the rate of pulmonary embolism (PE). We performed univariate and multivariate logistic regression analysis to determine risk factors associated with postoperative DVT.

Results

There were 4327 patients with PDAC who underwent DP. Of these, 1414 (32.7%) had NAT. Receipt of NAT was significantly associated with postoperative DVT requiring therapy (3.5% vs. 2.3%, p = 0.02), but was not associated with PE (p = 0.42). On MVA, NAT was associated with a 73% greater chance of developing postoperative DVT [odds ratio (OR) 1.73, 95% CI 1.18–2.55].

Conclusions

Patients who receive NAT prior to DP for PDAC are 73% more likely to develop postoperative DVT compared with upfront resection. As NAT becomes more commonplace, these high-risk patients should be prioritized for guideline-recommended extended duration prophylaxis.
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Metadata
Title
Neoadjuvant Chemotherapy is Associated with Increased Risk of Postoperative DVT After Distal Pancreatectomy for Pancreatic Adenocarcinoma: a NSQIP Analysis
Authors
Keenan J. Robbins, MBBS, MPHS
Kenneth F. Newcomer Jr., MD
Erica K. Barnell, MD, PhD
Michael A. Anzelmo, BS
Jingxia Liu, MD, PhD
William G. Hawkins, MD, FACS
Publication date
27-12-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14763-y

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