Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

TB Russell; PL Labib; F Ausania; E Pando; KJ Roberts; A Kausar; VK Mavroeidis; G Marangoni; SC Thomasset; AE Frampton; P Lykoudis; M Maglione; N Alhaboob; H Bari; AM Smith; D Spalding; P Srinivasan; BR Davidson; RH Bhogal; D Croagh; I Dominguez; R Thakkar; D Gomez; MA Silva; P Lapolla; A Mingoli; A Porcu; NS Shah; ZZR Hamady; B Al-Sarrieh; A Serrablo; S Aroori; PL Labib; TB Russell; A Streeter; J Denson; M Puckett; S-M Zhou; M Browning; S Aroori; F Ausania; E Pando; K Roberts; A Kausar; VK Mavroeidis; G Marangoni; S Thomasset; A Frampton; P Lykoudis; M Maglione; N Alhaboob; H Bari; A Smith; D Spalding; P Srinivasan; B Davidson; R Bhogal; D Croagh; I Dominguez; R Thakkar; D Gomez; M Silva; P Lapolla; A Mingoli; A Porcu; NS Shah; Z Hamady; B Al-Sarrieh; A Serrablo; C Gonzalez-Abos; N Fernandes; EG Moller; CD Taboada; R Pande; J Alfarah; S Bandyopadhyay; A Abdelrahim; A Khan; C Jordan; JRE Rees; H Blege; W Cambridge; O White; S Blacker; J Blackburn; C Sweeney; D Field; M Gouda; R Bellotti

Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

TB Russell
, PL Labib
, F Ausania
, E Pando
, KJ Roberts
, A Kausar
, VK Mavroeidis
, G Marangoni
, SC Thomasset
, AE Frampton
, P Lykoudis
, M Maglione
, N Alhaboob
, H Bari
, AM Smith
, D Spalding
, P Srinivasan
, BR Davidson
, RH Bhogal
, D Croagh

I Dominguez, R Thakkar, D Gomez, MA Silva, P Lapolla, A Mingoli, A Porcu, NS Shah, ZZR Hamady, B Al-Sarrieh, A Serrablo, S Aroori, PL Labib, TB Russell, A Streeter, J Denson, M Puckett, S-M Zhou, M Browning, S Aroori, F Ausania, E Pando, K Roberts, A Kausar, VK Mavroeidis, G Marangoni, S Thomasset, A Frampton, P Lykoudis, M Maglione, N Alhaboob, H Bari, A Smith, D Spalding, P Srinivasan, B Davidson, R Bhogal, D Croagh, I Dominguez, R Thakkar, D Gomez, M Silva, P Lapolla, A Mingoli, A Porcu, NS Shah, Z Hamady, B Al-Sarrieh, A Serrablo, C Gonzalez-Abos, N Fernandes, EG Moller, CD Taboada, R Pande, J Alfarah, S Bandyopadhyay, A Abdelrahim, A Khan, C Jordan, JRE Rees, H Blege, W Cambridge, O White, S Blacker, J Blackburn, C Sweeney, D Field, M Gouda, R Bellotti

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Abstract

Introduction
Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS.
Materials and methods
Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests.
Results
Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74% vs 63%, p = 0.004) and had less often experienced a serious postoperative complication (10% vs 18%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52% vs 73%, p = 0.0004) and less often commenced AC (58% vs 74%, p = 0.002).
Conclusion
In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.

Original language	English
Article number	106919
Journal	European Journal of Surgical Oncology
Volume	49
Issue number	9
Publication status	Published - 19 May 2023

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Russell, TB., Labib, PL., Ausania, F., Pando, E., Roberts, KJ., Kausar, A., Mavroeidis, VK., Marangoni, G., Thomasset, SC., Frampton, AE., Lykoudis, P., Maglione, M., Alhaboob, N., Bari, H., Smith, AM., Spalding, D., Srinivasan, P., Davidson, BR., Bhogal, RH., ... Bellotti, R. (2023). Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study. European Journal of Surgical Oncology, 49(9), Article 106919.

@article{eacd8d37d820452d89dd66ba783fde15,

title = "Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study",

abstract = "Introduction Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS. Materials and methods Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests. Results Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74\% vs 63\%, p = 0.004) and had less often experienced a serious postoperative complication (10\% vs 18\%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52\% vs 73\%, p = 0.0004) and less often commenced AC (58\% vs 74\%, p = 0.002). Conclusion In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.",

author = "TB Russell and PL Labib and F Ausania and E Pando and KJ Roberts and A Kausar and VK Mavroeidis and G Marangoni and SC Thomasset and AE Frampton and P Lykoudis and M Maglione and N Alhaboob and H Bari and AM Smith and D Spalding and P Srinivasan and BR Davidson and RH Bhogal and D Croagh and I Dominguez and R Thakkar and D Gomez and MA Silva and P Lapolla and A Mingoli and A Porcu and NS Shah and ZZR Hamady and B Al-Sarrieh and A Serrablo and S Aroori and PL Labib and TB Russell and A Streeter and J Denson and M Puckett and S-M Zhou and M Browning and S Aroori and F Ausania and E Pando and K Roberts and A Kausar and VK Mavroeidis and G Marangoni and S Thomasset and A Frampton and P Lykoudis and M Maglione and N Alhaboob and H Bari and A Smith and D Spalding and P Srinivasan and B Davidson and R Bhogal and D Croagh and I Dominguez and R Thakkar and D Gomez and M Silva and P Lapolla and A Mingoli and A Porcu and NS Shah and Z Hamady and B Al-Sarrieh and A Serrablo and C Gonzalez-Abos and N Fernandes and EG Moller and CD Taboada and R Pande and J Alfarah and S Bandyopadhyay and A Abdelrahim and A Khan and C Jordan and JRE Rees and H Blege and W Cambridge and O White and S Blacker and J Blackburn and C Sweeney and D Field and M Gouda and R Bellotti",

year = "2023",

month = may,

day = "19",

language = "English",

volume = "49",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "9",

}

Russell, TB, Labib, PL, Ausania, F, Pando, E, Roberts, KJ, Kausar, A, Mavroeidis, VK, Marangoni, G, Thomasset, SC, Frampton, AE, Lykoudis, P, Maglione, M, Alhaboob, N, Bari, H, Smith, AM, Spalding, D, Srinivasan, P, Davidson, BR, Bhogal, RH, Croagh, D, Dominguez, I, Thakkar, R, Gomez, D, Silva, MA, Lapolla, P, Mingoli, A, Porcu, A, Shah, NS, Hamady, ZZR, Al-Sarrieh, B, Serrablo, A, Aroori, S, Labib, PL, Russell, TB, Streeter, A, Denson, J, Puckett, M, Zhou, S-M, Browning, M, Aroori, S, Ausania, F, Pando, E, Roberts, K, Kausar, A, Mavroeidis, VK, Marangoni, G, Thomasset, S, Frampton, A, Lykoudis, P, Maglione, M, Alhaboob, N, Bari, H, Smith, A, Spalding, D, Srinivasan, P, Davidson, B, Bhogal, R, Croagh, D, Dominguez, I, Thakkar, R, Gomez, D, Silva, M, Lapolla, P, Mingoli, A, Porcu, A, Shah, NS, Hamady, Z, Al-Sarrieh, B, Serrablo, A, Gonzalez-Abos, C, Fernandes, N, Moller, EG, Taboada, CD, Pande, R, Alfarah, J, Bandyopadhyay, S, Abdelrahim, A, Khan, A, Jordan, C, Rees, JRE, Blege, H, Cambridge, W, White, O, Blacker, S, Blackburn, J, Sweeney, C, Field, D, Gouda, M & Bellotti, R 2023, 'Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study', European Journal of Surgical Oncology, vol. 49, no. 9, 106919.

TY - JOUR

T1 - Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

AU - Russell, TB

AU - Labib, PL

AU - Ausania, F

AU - Pando, E

AU - Roberts, KJ

AU - Kausar, A

AU - Mavroeidis, VK

AU - Marangoni, G

AU - Thomasset, SC

AU - Frampton, AE

AU - Lykoudis, P

AU - Maglione, M

AU - Alhaboob, N

AU - Bari, H

AU - Smith, AM

AU - Spalding, D

AU - Srinivasan, P

AU - Davidson, BR

AU - Bhogal, RH

AU - Croagh, D

AU - Dominguez, I

AU - Thakkar, R

AU - Gomez, D

AU - Silva, MA

AU - Lapolla, P

AU - Mingoli, A

AU - Porcu, A

AU - Shah, NS

AU - Hamady, ZZR

AU - Al-Sarrieh, B

AU - Serrablo, A

AU - Aroori, S

AU - Labib, PL

AU - Russell, TB

AU - Streeter, A

AU - Denson, J

AU - Puckett, M

AU - Zhou, S-M

AU - Browning, M

AU - Aroori, S

AU - Ausania, F

AU - Pando, E

AU - Roberts, K

AU - Kausar, A

AU - Mavroeidis, VK

AU - Marangoni, G

AU - Thomasset, S

AU - Frampton, A

AU - Lykoudis, P

AU - Maglione, M

AU - Alhaboob, N

AU - Bari, H

AU - Smith, A

AU - Spalding, D

AU - Srinivasan, P

AU - Davidson, B

AU - Bhogal, R

AU - Croagh, D

AU - Dominguez, I

AU - Thakkar, R

AU - Gomez, D

AU - Silva, M

AU - Lapolla, P

AU - Mingoli, A

AU - Porcu, A

AU - Shah, NS

AU - Hamady, Z

AU - Al-Sarrieh, B

AU - Serrablo, A

AU - Gonzalez-Abos, C

AU - Fernandes, N

AU - Moller, EG

AU - Taboada, CD

AU - Pande, R

AU - Alfarah, J

AU - Bandyopadhyay, S

AU - Abdelrahim, A

AU - Khan, A

AU - Jordan, C

AU - Rees, JRE

AU - Blege, H

AU - Cambridge, W

AU - White, O

AU - Blacker, S

AU - Blackburn, J

AU - Sweeney, C

AU - Field, D

AU - Gouda, M

AU - Bellotti, R

PY - 2023/5/19

Y1 - 2023/5/19

N2 - Introduction Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS. Materials and methods Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests. Results Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74% vs 63%, p = 0.004) and had less often experienced a serious postoperative complication (10% vs 18%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52% vs 73%, p = 0.0004) and less often commenced AC (58% vs 74%, p = 0.002). Conclusion In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.

AB - Introduction Adjuvant chemotherapy (AC) can prolong overall survival (OS) after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). However, fitness for AC may be influenced by postoperative recovery. We aimed to investigate if serious (Clavien-Dindo grade ≥ IIIa) postoperative complications affected AC rates, disease recurrence and OS. Materials and methods Data were extracted from the Recurrence After Whipple's (RAW) study (n = 1484), a retrospective study of PD outcomes (29 centres from eight countries). Patients who died within 90-days of PD were excluded. The Kaplan-Meier method was used to compare OS in those receiving or not receiving AC, and those with and without serious postoperative complications. The groups were then compared using univariable and multivariable tests. Results Patients who commenced AC (vs no AC) had improved OS (median difference: (MD): 201 days), as did those who completed their planned course of AC (MD: 291 days, p < 0.0001). Those who commenced AC were younger (mean difference: 2.7 years, p = 0.0002), more often (preoperative) American Society of Anesthesiologists (ASA) grade I-II (74% vs 63%, p = 0.004) and had less often experienced a serious postoperative complication (10% vs 18%, p = 0.002). Patients who developed a serious postoperative complication were less often ASA grade I-II (52% vs 73%, p = 0.0004) and less often commenced AC (58% vs 74%, p = 0.002). Conclusion In our multicentre study of PD outcomes, PDAC patients who received AC had improved OS, and those who experienced a serious postoperative complication commenced AC less frequently. Selected high-risk patients may benefit from targeted preoperative optimisation and/or neoadjuvant chemotherapy.

UR - https://pearl.plymouth.ac.uk/pms-research/1879/

M3 - Article

SN - 0748-7983

VL - 49

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 9

M1 - 106919

ER -

Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study

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