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Background <p>Complications after pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) are associated with delays or omission of adjuvant chemotherapy (AC). Similar data for patients who undergo distal pancreatectomy (DP) are lacking.</p> Methods <p>A retrospective cohort study was conducted using the SEER-Medicare database to identify patients who underwent upfront DP for PDAC (2010–2019). Multilevel logistic regression and Cox proportional hazards models were used to evaluate the association of postoperative complications with AC omission and delay as well as survival endpoints based on receipt of AC.</p> Results <p>Of 1029 patients identified, 613 (59.6 %) received AC. Patients with complications had lower rates of AC (50.0 % vs 61.1 %; <i>p</i> = 0.013) and multi-agent AC (25.0 % vs 28.2 %; <i>p</i> = 0.039) and higher rates of delays in AC (42.9 % vs 21.4 %; <i>p</i> &lt; 0.001) than those without complications. In multivariable analysis, complications were associated with a lower rate of AC (hazard ratio [HR], 0.67; 95 % confidence interval [CI], 0.54–0.84; <i>p</i> &lt; 0.001) and a higher rate of delayed AC (odds ratio [OR], 3.36; 95 % CI 1.92–5.91; <i>p</i> &lt; 0.001). For survival, receipt of AC overall (HR, 0.56; 95 % CI 0.47–0.67; <i>p</i> &lt; 0.001), even when delayed (HR, 0.72; 95 % CI 0.57–0.90; <i>p</i> = 0.005), was associated with better overall survival (OS) than no AC. However, delayed AC was associated with worse OS than timely AC (HR, 1.27; 95 % CI 1.01–1.62; <i>p</i> = 0.04).</p> Conclusions <p>Patients who experienced a postoperative complication after DP for left-side PDAC had lower rates of AC overall and higher rates of delayed AC, both associated with worse OS.</p>

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Do Postoperative Complications Impact Adjuvant Chemotherapy in Patients Undergoing Left-Side Pancreatectomy for Pancreatic Cancer?

  • 期刊论文

  • 发表日期：

    2026年5月2日

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  • Dillon C. Cheung,
  • Stephanie Yu,
  • Chee-Chee Stucky,
  • Lena Egbert,
  • J. Asher Jenkins,
  • Chi-Fu Jeffrey Yang,
  • Alexandra L. Potter,
  • George C. Linderman,
  • Richard J. Bold,
  • Nabil Wasif,
  • Yu-Hui Chang,
  • Elizabeth B. Habermann,
  • Zhi Ven Fong

摘要

Background

Complications after pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) are associated with delays or omission of adjuvant chemotherapy (AC). Similar data for patients who undergo distal pancreatectomy (DP) are lacking.

Methods

A retrospective cohort study was conducted using the SEER-Medicare database to identify patients who underwent upfront DP for PDAC (2010–2019). Multilevel logistic regression and Cox proportional hazards models were used to evaluate the association of postoperative complications with AC omission and delay as well as survival endpoints based on receipt of AC.

Results

Of 1029 patients identified, 613 (59.6 %) received AC. Patients with complications had lower rates of AC (50.0 % vs 61.1 %; p = 0.013) and multi-agent AC (25.0 % vs 28.2 %; p = 0.039) and higher rates of delays in AC (42.9 % vs 21.4 %; p < 0.001) than those without complications. In multivariable analysis, complications were associated with a lower rate of AC (hazard ratio [HR], 0.67; 95 % confidence interval [CI], 0.54–0.84; p < 0.001) and a higher rate of delayed AC (odds ratio [OR], 3.36; 95 % CI 1.92–5.91; p < 0.001). For survival, receipt of AC overall (HR, 0.56; 95 % CI 0.47–0.67; p < 0.001), even when delayed (HR, 0.72; 95 % CI 0.57–0.90; p = 0.005), was associated with better overall survival (OS) than no AC. However, delayed AC was associated with worse OS than timely AC (HR, 1.27; 95 % CI 1.01–1.62; p = 0.04).

Conclusions

Patients who experienced a postoperative complication after DP for left-side PDAC had lower rates of AC overall and higher rates of delayed AC, both associated with worse OS.