Surgical Outcome After Pancreatoduodenectomy for Duodenal Adenocarcinoma Compared with Other Periampullary Cancers: A Nationwide Audit Study

Jacob K. de Bakker, J. Annelie Suurmeijer, the Dutch Pancreatic Cancer Group, Jurgen G.J. Toennaer, Bert A. Bonsing, Olivier R. Busch, Casper H. van Eijck, Ignace H. de Hingh, Vincent E. de Meijer, I. Quintus Molenaar, Hjalmar C. van Santvoort, Martijn W. Stommel, Sebastiaan Festen, Erwin van der Harst, Gijs Patijn, Daan J. Lips, Marcel Den Dulk, Koop Bosscha, Marc G. Besselink*, Geert Kazemier*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background: Surgical outcome after pancreatoduodenectomy for duodenal adenocarcinoma could differ from pancreatoduodenectomy for other cancers, but large multicenter series are lacking. This study aimed to determine surgical outcome in patients after pancreatoduodenectomy for duodenal adenocarcinoma, compared with other periampullary cancers, in a nationwide multicenter cohort. Methods: After pancreatoduodenectomy for cancer between 2014 and 2019, consecutive patients were included from the nationwide, mandatory Dutch Pancreatic Cancer Audit. Patients were stratified by diagnosis. Baseline, treatment characteristics, and postoperative outcome were compared between groups. The association between diagnosis and major complications (Clavien–Dindo grade III or higher) was assessed via multivariable regression analysis. Results: Overall, 3113 patients, after pancreatoduodenectomy for cancer, were included in this study: 264 (8.5%) patients with duodenal adenocarcinomas and 2849 (91.5%) with other cancers. After pancreatoduodenectomy for duodenal adenocarcinoma, patients had higher rates of major complications (42.8% vs. 28.6%; p < 0.001), postoperative pancreatic fistula (International Study Group of Pancreatic Surgery [ISGPS] grade B/C; 23.1% vs. 13.4%; p < 0.001), complication-related intensive care admission (14.3% vs. 10.3%; p = 0.046), re-interventions (39.8% vs. 26.6%; p < 0.001), in-hospital mortality (5.7% vs. 3.1%; p = 0.025), and longer hospital stay (15 days vs. 11 days; p < 0.001) compared with pancreatoduodenectomy for other cancers. In multivariable analysis, duodenal adenocarcinoma was independently associated with major complications (odds ratio 1.14, 95% confidence interval 1.03–1.27; p = 0.011). Conclusion: Pancreatoduodenectomy for duodenal adenocarcinoma is associated with higher rates of major complications, pancreatic fistula, re-interventions, and in-hospital mortality compared with patients undergoing pancreatoduodenectomy for other cancers. These findings should be considered in patient counseling and postoperative management.

Original languageEnglish
Pages (from-to)2448-2455
Number of pages8
JournalAnnals of Surgical Oncology
Volume30
Issue number4
Early online date19 Dec 2022
DOIs
Publication statusPublished - Apr 2023

Bibliographical note

Funding Information:
This study was not preregistered. Deltaplan Alvleesklierkanker supports the DPCG.

Publisher Copyright:
© 2022, The Author(s).

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