Sara L Zettervall, MD, Jeremy Holzmacher, MD, Paul P Lin, MD, Khashayar Vaziri, MD, Tammy Ju, MD. George Washington University Medical Center
Background: The role of neoadjuvent chemotherapy on the treatment of pancreatic cancer remains widely controversial. Studies have evaluated its effect on resectability and survival; however, few have studied the consequence of neoadjuvent therapy on surgical outcomes and complications.
Methods and Procedures: A retrospective analysis was performed utilizing the targeted pancreas module of the National Surgical Quality Improvement Project (NSQIP) for patients undergoing pancreaticoduodenectomy. Neoadjuvent therapy was defined by chemotherapy and/or radiation in the 30-days before surgery. Patient demographics, operative characteristics, and 30-day outcomes were compared amongst patients undergoing neoadjuvent chemotherapy, radiation, chemoradiation, and no neoadjuvent therapy. Both univariable and multivariable analysis were completed.
Results: Pancreaticoduodenectomy was completed in 3,114 patients. 2,635 patients had no neoadjuvent therapy; 207 underwent both chemotherapy and radiation; 256 underwent chemotherapy alone, and 16 underwent radiation alone. There were no differences in demographics or comorbidities. No difference in 30-day mortality was found; however pancreatic fistula formation was affected by neoadjuvent therapy. Neoadjuvant radiation increased fistula formation (OR: 2.4, 95% CI: 1.1-5.2) while neoadjuvent chemotherapy (OR: 0.5, 95% CI: 0.3-0.99) was protective.
Conclusion: Neoadjuvent therapy significantly impacts surgical outcomes following pancreaticoduodenectomy. Given that pancreatic fistula formation can delay post-operative chemotherapy, it may be reasonable to refrain from neoadjuvent radiation therapy for patients with resectable and borderline-resectable disease. 
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88215
Program Number: P526
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster