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Background <p>Up to 40% of patients undergoing pancreatoduodenectomy (PD) for resectable pancreatic ductal adenocarcinoma do not receive adjuvant chemotherapy (aCT). This study aimed to evaluate the impact of postoperative pancreatic fistula (POPF) on aCT delivery and timing and to explore how preoperative variables influence these outcomes according to the occurrence of a POPF.</p> Methods <p>This multicenter retrospective study included patients from 25 pancreatic centers. Propensity score matching was performed based on anatomical, biological, and conditional variables. Multivariable regression analyses were used to identify independent predictors of aCT omission and delay.</p> Results <p>Among 1590 patients, 267 (16.8%) developed a POPF. Overall, aCT was administrated in 1,146 patients (72.1%) with a median time to first dose delivery of 56 days (26). After matching, POPF was associated with a significantly lower likelihood of aCT delivery (<i>p</i> &lt; 0.001) and a significant delay in its initiation (<i>p</i> &lt; 0.001). Independent predictors of aCT omission were age ≥&#xa0;70 (odds ratio [OR] 2.480, 95% confidence interval [CI] 1.439–4.274; <i>p</i> &lt; 0.001), chronic renal failure (OR 4.554, 95% CI 1.320–15.708; <i>p</i> = 0.016), and chronic obstructive pulmonary disease (OR 2.775, 95% CI 1.021–7.546; <i>p</i> = 0.045) when POPF occurred. In the absence of POPF, apart from age ≥&#xa0;70, venous contact (OR 1.574, 95% CI 1.114–2.224; <i>p</i> = 0.010) and tumor size &gt; 20 mm (OR 0.713, 95% CI 0.523–0.972; <i>p</i> = 0.032) were predictors of aCT delivery.</p> Conclusions <p>Postoperative pancreatic fistula is a key driver of aCT delivery after pancreatoduodenectomy. Its interaction with patient frailty highlights the need for preoperative risk assessment to better select candidates for upfront surgery in resectable pancreatic ductal adenocarcinoma.</p>

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Preoperative Risk Assessment of Pancreatic Fistula Impact on Adjuvant Chemotherapy Delivery After Pancreatoduodenectomy

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Fabio Giannone,
  • Marco Palucci,
  • Gianluca Cassese,
  • Giovanni Capretti,
  • Michael Ginesini,
  • Abdallah Iben-Khayat,
  • Raffaele Vincenzo De Rosa,
  • Claudio Ricci,
  • Cristian Dumitru Lupascu,
  • Ugo Marchese,
  • Patricia Sánchez-Velázquez,
  • Roberta Rossi,
  • Rami Rhaiem,
  • Guillaume Deloche,
  • Gianluca Rompianesi,
  • Marta Fernández-Baeza,
  • Salvatore Gruttadauria,
  • Ender Dulundu,
  • Gian Luca Baiocchi,
  • Marcello Spampinato,
  • Riccardo Memeo,
  • Isabella Frigerio,
  • Quentin Chenevas-Paule,
  • Marco Miggino,
  • Gian Luca Grazi,
  • Giorgio Ercolani,
  • Francisco Espin,
  • Mario Serradilla-Martín,
  • Roberto Ivan Troisi,
  • Stephanie Truant,
  • Tullio Piardi,
  • Marco Vivarelli,
  • Patrick Pessaux,
  • Benedetto Ielpo,
  • Stylianos Tzedakis,
  • Andrei Chicos,
  • Riccardo Casadei,
  • Laurent Sulpice,
  • Olivier Saint-Marc,
  • Ugo Boggi,
  • Alessandro Zerbi,
  • Fabrizio Panaro,
  • Serena Penpa,
  • Giacomo Ambrogi,
  • Antonio Luberto,
  • Virginia Viti,
  • Lucrezia Lami,
  • Jean-Emmanuel Langdorph,
  • Anis Zerouki,
  • Édouard Wasielewski,
  • Fabien Robin,
  • Carlo Ingaldi,
  • Vincenzo D’Ambra,
  • Doris Da Silva,
  • Tiziana Marchese

摘要

Background

Up to 40% of patients undergoing pancreatoduodenectomy (PD) for resectable pancreatic ductal adenocarcinoma do not receive adjuvant chemotherapy (aCT). This study aimed to evaluate the impact of postoperative pancreatic fistula (POPF) on aCT delivery and timing and to explore how preoperative variables influence these outcomes according to the occurrence of a POPF.

Methods

This multicenter retrospective study included patients from 25 pancreatic centers. Propensity score matching was performed based on anatomical, biological, and conditional variables. Multivariable regression analyses were used to identify independent predictors of aCT omission and delay.

Results

Among 1590 patients, 267 (16.8%) developed a POPF. Overall, aCT was administrated in 1,146 patients (72.1%) with a median time to first dose delivery of 56 days (26). After matching, POPF was associated with a significantly lower likelihood of aCT delivery (p < 0.001) and a significant delay in its initiation (p < 0.001). Independent predictors of aCT omission were age ≥ 70 (odds ratio [OR] 2.480, 95% confidence interval [CI] 1.439–4.274; p < 0.001), chronic renal failure (OR 4.554, 95% CI 1.320–15.708; p = 0.016), and chronic obstructive pulmonary disease (OR 2.775, 95% CI 1.021–7.546; p = 0.045) when POPF occurred. In the absence of POPF, apart from age ≥ 70, venous contact (OR 1.574, 95% CI 1.114–2.224; p = 0.010) and tumor size > 20 mm (OR 0.713, 95% CI 0.523–0.972; p = 0.032) were predictors of aCT delivery.

Conclusions

Postoperative pancreatic fistula is a key driver of aCT delivery after pancreatoduodenectomy. Its interaction with patient frailty highlights the need for preoperative risk assessment to better select candidates for upfront surgery in resectable pancreatic ductal adenocarcinoma.