Delayed Recovery after Pancreaticoduodenectomy: A Major Factor Impairing the Delivery of Adjuvant Therapy?

• Published in: Journal of the American College of Surgeons Vol. 204; no. 3; pp. 347 - 355
• Main Authors: Aloia, Thomas E., MD, Lee, Jeffrey E., MD, FACS, Vauthey, Jean-Nicolas, MD, FACS, Abdalla, Eddie K., MD, FACS, Wolff, Robert A., MD, Varadhachary, Gauri R., MD, Abbruzzese, James L., MD, FACP, Crane, Christopher H., MD, Evans, Douglas B., MD, FACS, Pisters, Peter W.T., MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2007; Elsevier Science
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adolescent; Adult; Aged; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Chemotherapy, Adjuvant; Elective Surgical Procedures - methods; Female; Follow-Up Studies; General aspects; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - radiotherapy; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Prospective Studies; Radiotherapy, Adjuvant; Risk Factors; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Treatment Outcome; AT; PS; PD; pancreaticoduodenectomy; ECOG; Eastern Cooperative Oncology Group; adjuvant therapy; performance status; Medicine; Duodenum; Surgery; Adjuvant treatment; Delivery; Pancreas; Recovery; Delay; Pancreatoduodenectomy
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2006.12.011

Background Delayed recovery after pancreaticoduodenectomy (PD) is believed to preclude adjuvant therapy for approximately 30% of patients who undergo elective PD as initial treatment for pancreatic adenocarcinoma. This study reexamined the frequency of delayed recovery and assessed other factors associated with adjuvant therapy administration after PD at a high-volume center. Study Design Preoperative and perioperative variables were reviewed in a consecutive series of 85 patients with pancreatic adenocarcinoma undergoing PD without preoperative chemotherapy or radiotherapy from 1990 to 2004. Results Study groups included patients undergoing emergency PD (group 1, n = 13); elective PD with good preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) (group 2, ECOG PS: 0 to 1, n = 63); and elective PD with marginal preoperative PS (group 3, ECOG PS: 2 to 3, n = 9). Delayed recovery of PS precluded adjuvant therapy in 23% of patients in group 1, 6% of patients in group 2, and 44% of patients in group 3 (p = 0.0001). Conclusions The impact of delayed recovery after PD on the delivery of adjuvant therapy depends on the urgency of surgery and the preoperative PS. For patients with good preoperative PS who undergo elective PD at a high-volume center, it is uncommon for delayed recovery to preclude delivery of adjuvant therapy.