Work

Delayed gastric emptying after pancreatic cancer surgery impacts time to start of adjuvant treatment but not overall survival: a post-hoc analysis of the PREOPANC-1 and -2 trials

Year: 2025

Type: article

Abstract: Overall survival (OS) among patients with pancreatic ductal adenocarcinoma (PDAC) remains poor. The most favourable OS is obtained by combining surgical resection with systemic chemo(radio)therapy. Complications following pancreatic surgery occur in nearly 50% of patients. Major complications (Clavien–Dindo ≥3) are negatively associated with OS, mediated by the omission of adjuvant chemotherapy1. Delayed gastric emptying (DGE), affecting 20% of patients, is the most frequent complication following pancreatic surgery2. DGE is associated with prolonged hospital stay, reduced quality of life, and a negative association of DGE grade C and cancer-specific survival is suggested3. However, the impact of DGE on initiation and completion of adjuvant chemotherapy and subsequent OS in patients with PDAC is unknown. Therefore, the current study aimed to evaluate the association between DGE grade B/C and the timing and completion of adjuvant chemotherapy along with OS, in patients with PDAC following pancreatic resection. This post-hoc analysis of the PREOPANC-1 and -2 RCTs included patients who underwent resection for resectable and borderline resectable PDAC across 20 Dutch centres between 2013 and 20214,5. Study designs are shown in Fig. S1. Primary outcome was the association between DGE and initiation and completion of adjuvant therapy and OS. OS was estimated using the Kaplan–Meier method and compared between groups using the log-rank test. Multivariable Cox proportional hazards models assessed the association between DGE and OS. A subgroup analysis evaluated primary DGE in relation to oncological outcomes. Methodological details and definitions are provided in the Supplementary material.

Source: British journal of surgery

DOI: 10.1093/bjs/znaf261