Neoadjuvant Therapy At Local Or Outside Institutions Does Not Adversely Impact Surgical Timing Or Long-term Outcomes In Patients With Pancreatic Adenocarcinoma
*Rachel C Kim, *Kara A Allen, *Alexandra M Roch, *Sean P McGuire, Eugene P Ceppa, Nicholas J Zyromski, Attila Nakeeb, Michael G House, C Maximillian Schmidt, Trang K Nguyen
Indiana University School of Medicine, Indianapolis, IN
OBJECTIVE(S): Although high-volume centers are known to have better surgical outcomes, patients with pancreatic adenocarcinoma (PDAC) often elect to receive chemotherapy at treatment centers closer to home. This study aims to determine whether treatment site of neoadjuvant therapy relative to surgery location impacts surgical timing and long-term outcomes.
METHODS: All patients with PDAC who underwent oncologic resection at a single, high-volume institution between January 2016 and February 2020 and had neoadjuvant chemotherapy prior to surgery were queried from a prospectively maintained database. Patients were sorted based on location of neoadjuvant chemotherapy. Groups were compared using chi-squared tests, one-way ANOVA for normally distributed variables, or Kruskal-Wallis one-way ANOVA for nonparametric variables.
RESULTS: A total of 189 patients with PDAC who had neoadjuvant chemotherapy underwent surgery in the studied timeframe, of which 10 were excluded due to incomplete data from outside institutions, leaving 179 patients that were included in the study. Operations included 145 pancreatoduodenectomies, 29 distal pancreatectomies, and 5 total pancreatectomies. Seventy-four (41.3%) patients received neoadjuvant chemotherapy at the same institution as their surgery (group A), 20 (11.2%) received chemotherapy outside of their surgical institution but within the same hospital/healthcare system (group B), and 85 (47.5%) received chemotherapy at an outside healthcare system (group C). Time from completion of neoadjuvant therapy to surgery was not significantly different between groups (A vs. B vs. C median [IQR]: 34.5 vs. 41.5 vs. 36 days, p=0.08). Thirty-day readmission rate was lower in group A (n (%): 1(1.4%) vs. 2(10.0%) vs. 11(12.9%), p=0.02), however 90-day mortality and one-year survival rates were similar. Overall survival also did not differ significantly between groups on Kaplan-Meier survival analysis (p=0.08, Figure 1)
CONCLUSIONS: Patients may receive neoadjuvant therapy at local centers without impacting surgical scheduling. Although these patients may experience higher postoperative readmission rates, perioperative mortality and long-term survival are not adversely affected by location of chemotherapy. Multidisciplinary care can be effectively practiced in different locations without affecting overall outcomes in patients with PDAC.
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