Neoadjuvant Chemotherapy is Associated with Increased Risk of Postoperative DVT After Distal Pancreatectomy for Pancreatic Adenocarcinoma: a NSQIP Analysis

• Published in: Annals of surgical oncology Vol. 31; no. 5; pp. 2873 - 2881
• Main Authors: Robbins, Keenan J., Newcomer, Kenneth F., Barnell, Erica K., Anzelmo, Michael A., Liu, Jingxia, Hawkins, William G.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2024; Springer Nature B.V
• Subjects: Adenocarcinoma; Adenocarcinoma - complications; Adenocarcinoma - drug therapy; Adenocarcinoma - surgery; Adult; Cancer; Chemotherapy; Embolism; Humans; Medicine; Medicine & Public Health; Morbidity; Neoadjuvant Therapy - adverse effects; Oncology; Pancreas; Pancreatectomy; Pancreatectomy - adverse effects; Pancreatic cancer; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Postoperative Complications - etiology; Postoperative Complications - surgery; Prophylaxis; Pulmonary Embolism; Quality control; Quality Improvement; Risk Factors; Risk groups; Surgery; Surgical Oncology; Thromboembolism; Thrombosis; Venous Thromboembolism - etiology; Venous Thrombosis - surgery
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-14763-y

Background Venous thromboembolism (VTE) remains a persistent source of postoperative morbidity despite prevention and mitigation efforts. Cancer, surgery, and chemotherapy are known risk factors for VTE. Existing literature suggests that neoadjuvant therapy (NAT) may contribute to increased VTE risk in the postoperative period, but few authors specifically examine this relationship in distal pancreatic adenocarcinoma (PDAC). In this study, we analyze the association of NAT and postoperative VTE in patients who underwent distal pancreatectomy (DP) for PDAC. Patients and Methods Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, we analyzed the Procedure Targeted files for pancreatectomy from 2014 to 2020. Adults with PDAC who underwent DP were grouped by receipt of NAT. The primary outcome was the rate of deep venous thrombosis (DVT) and the secondary outcome was the rate of pulmonary embolism (PE). We performed univariate and multivariate logistic regression analysis to determine risk factors associated with postoperative DVT. Results There were 4327 patients with PDAC who underwent DP. Of these, 1414 (32.7%) had NAT. Receipt of NAT was significantly associated with postoperative DVT requiring therapy (3.5% vs. 2.3%, p = 0.02), but was not associated with PE ( p = 0.42). On MVA, NAT was associated with a 73% greater chance of developing postoperative DVT [odds ratio (OR) 1.73, 95% CI 1.18–2.55]. Conclusions Patients who receive NAT prior to DP for PDAC are 73% more likely to develop postoperative DVT compared with upfront resection. As NAT becomes more commonplace, these high-risk patients should be prioritized for guideline-recommended extended duration prophylaxis.