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Weight Loss During Neoadjuvant Chemotherapy Impacts Perioperative Outcomes In Patients Undergoing Surgery For Pancreatic Cancer
*Sahil B Doshi, Akhil Chawla
Northwestern University Feinberg School of Medicine, Chicago, IL

OBJECTIVE(S): While use of neoadjuvant chemotherapy (NAC) in pancreatic adenocarcinoma (PDAC) increases tolerability of systemic therapy prior to surgery, weight loss during the neoadjuvant period is an area of concern. The goal of this study is to determine the effect of weight loss during NAC on perioperative outcomes of pancreatectomies.
METHODS: The NSQIP database 2014-2019 was utilized to study patients who received NAC for PDAC and underwent significant weight loss, defined as at least 10% body weight loss in the six months prior to surgery. Univariate and multivariate analyses were conducted using Fisherís Exact Test, Pearsonís Chi-squared Test, and logistic regression.
RESULTS: Of the 5,590 PDAC patients who received NAC, 913 (16%) experienced significant weight loss. Patients who experienced significant weight loss were more likely to experience at least one complication compared to those who did not undergo weight loss (18% vs. 16%, p=0.05). Those who had significant weight loss were more likely to undergo unplanned intubation postoperatively (3.8%vs2.2%, p=0.004), have postoperative ventilator need >48 hours (3.7%vs1.8%, p<0.001), have postoperative septic shock (3.9%vs1.8%, p<0.001), and undergo reoperation (6.0%vs4.3%, p=0.027). However, there were no differences for pancreatic fistula (7.7%vs9.3%, p=0.15), readmission rates (15%vs15%, p=0.7), or 30-day mortality (1.5%vs1.2%, p=0.5). Utilizing logistic regression, significant weight loss (OR=1.18, p=0.028), male sex (OR=1.26, p<0.001), COPD (OR=1.38, p=0.029), hypertensive medication use (OR=1.20, p<0.001), and soft gland texture (OR=1.28, p=0.002) were independent predictors of a post-operative complication.
CONCLUSIONS: Nutritional measures to stabilize weight during NAC should be considered to decrease post-pancreatectomy complications.

Univariate and multivariate regression evaluating factors that predict a perioperative complication
Univariate Odds Ratio (95% CI)Univariate P-valueMultivariate Odds Ratio (95% CI)Multivariate P-value
Significant Weight Loss1.04 (1.00, 1.07)0.051.18 (1.02, 1.36)0.028
Age1.00 (1.00, 1.00)0.3--
Male Sex1.06 (1.03, 1.08)<0.0011.26 (1.13, 1.40)<0.001
Diabetes0.99 (0.96, 1.02)0.2--
History of COPD1.09 (1.02, 1.17)0.0111.38 (1.03, 1.84)0.029
Hypertensive Medication Use1.05 (1.02, 1.07)<0.0011.20 (1.08, 1.34)<0.001
Pancreatic Duct Size (ref: <3 mm)0.95 (0.90, 1.00) (>6 mm)0.0380.84 (0.68, 1.04)0.10
Pancreatic Gland Texture (ref: Hard Texture)1.06 (1.03, 1.10) (Soft Texture)0.0111.28 (1.10, 1.49)0.002


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