The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma.
The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma.
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DOI：
10.1245/s10434-014-3722-6
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发表时间：
2014-09
影响因子：
3.7
通讯作者：
Weiss MJ
中科院分区：
文献类型：
--
作者：
Wu W;He J;Cameron JL;Makary M;Soares K;Ahuja N;Rezaee N;Herman J;Zheng L;Laheru D;Choti MA;Hruban RH;Pawlik TM;Wolfgang CL;Weiss MJ
术后并发症对腺癌患者行胰腺十二指肠切除术后辅助治疗的影响尚不清楚。我们对1995-2011年间在我们机构接受PD治疗的所有患者进行了回顾。分析临床病理资料，包括Clavien-Dindo并发症分级、辅助治疗时间(TTA)和生存期。1995至2011年间，共有1144名腺癌患者接受了PD治疗。总并发症发生率为49.1%，临床严重并发症(≥IIIb)发生率为4.2%。总体而言，已知有621名患者(54.3%)接受过辅助治疗。中位TTA为60天。虽然并发症的出现与TTA的延迟有关(p=0.002)，但并发症的程度并不相关(p=0.112)。在多变量分析中，只有年龄和68岁(p<；0.001)和住院时间和9天(p=0.002)与非辅助治疗相关。术后有并发症的患者接受单一辅助化疗或放射治疗的可能性(31.4%)高于无并发症的患者(17.1%；p<；0.001)。与有并发症的患者相比，无并发症的患者的中位生存期更长(19.5月比16.1月；p=0.001)。接受辅助治疗的没有并发症的患者比没有接受辅助治疗的有并发症的患者的中位生存期更长(22.5vs.10.7个月；p<；0.001)。多因素分析显示并发症[危险比(HR)1.16；p=0.023]和辅助治疗(HR 0.67；p<；0.001)与生存有关。腺癌PD术后并发症和无辅助治疗是常见的。术后并发症延迟了TTA，降低了综合辅助治疗的可能性。确定并发症风险增加的患者和那些不太可能接受辅助治疗的患者需要进一步研究，因为他们可能从新辅助治疗中受益。
The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy (PD) for adenocarcinoma is still unclear. A retrospective review of all patients undergoing PD at our institution between 1995 and 2011 was performed. Clinicopathological data, including Clavien–Dindo complication grade, time to adjuvant therapy (TTA), and survival, were analyzed. A total of 1,144 patients underwent PD for adenocarcinoma between 1995 and 2011. The overall complication rate was 49.1 % and clinically severe complications (≥IIIb) occurred in 4.2 %. Overall, 621 patients (54.3 %) were known to have received adjuvant therapy. The median TTA was 60 days. Although the presence of a complication was associated with a delay in TTA (p = 0.002), the grade of complication was not (p = 0.112). On multivariate analysis, only age > 68 years (p < 0.001) and length of stay >9 days (p = 0.002) correlated with no adjuvant therapy. Patients with postoperative complications were more likely to receive single adjuvant chemotherapy or radiation therapy (31.4 %) than were patients without complications (17.1 %; p < 0.001). Patients without a complication had a longer median survival compared with patients who experienced complications (19.5 vs. 16.1 months; p = 0.001). Patients without complications who received adjuvant therapy had longer median survival than patients with complications who received no adjuvant therapy (22.5 vs. 10.7 months; p < 0.001). Multivariate analysis demonstrated that complications [hazard ratio (HR) 1.16; p = 0.023] and adjuvant therapy (HR 0.67; p <0.001) were related to survival. Complications and no adjuvant therapy are common following PD for adenocarcinoma. Postoperative complications delay TTA and reduce the likelihood of multimodality adjuvant therapy. Identifying patients at increased risk for complications and those unlikely to receive adjuvant therapy warrants further investigation as they may benefit from a neoadjuvant approach.
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影响因子：
3.7
作者：
Hsu CC;Herman JM;Corsini MM;Winter JM;Callister MD;Haddock MG;Cameron JL;Pawlik TM;Schulick RD;Wolfgang CL;Laheru DA;Farnell MB;Swartz MJ;Gunderson LL;Miller RC
通讯作者：
Miller RC
影响因子：
6.2
作者：
Hershman, Dawn;Hall, Michael J.;Neugut, Alfred I.
通讯作者：
Neugut, Alfred I.
影响因子：
9
作者：
Cameron, JL;Riall, TS;Belcher, KA
通讯作者：
Belcher, KA
影响因子：
8.4
作者：
Des Guetz, Gaetan;Nicolas, Patrick;Uzzan, Bernard
通讯作者：
Uzzan, Bernard
影响因子：
3.8
作者：
Bassi, C;Dervenis, C;Buchler, M
通讯作者：
Buchler, M