ASO Author Reflections: Association Between Neoadjuvant Chemoradiotherapy and Intractable Serous Ascites After Pancreati
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Association Between Neoadjuvant Chemoradiotherapy and Intractable Serous Ascites After Pancreaticoduodenectomy for Pancreatic Cancer Atsushi Tomioka, MD
, and Kazuhisa Uchiyama, PhD
Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
PAST Intractable serous (not chylous) ascites (IA) that develops early following pancreatic resection for pancreatic cancer is an infrequent complication. Despite this, there have been eight cases in our institution from 2012 to 2020. IA delays or inhibits initiation of adjuvant chemotherapy and worsens the nutritional status of the patient. Although IA is a life-threatening problem, the cause and mechanism remain unknown, and a radical cure has not yet been established. In the current study,1 we sought to identify risk factors associated with IA following pancreatic resection and considered the underlying mechanisms. PRESENT This single-center retrospective study included 92 patients who underwent pancreaticoduodenectomy for pancreatic cancer.1 The IA group had poorer prognosis than the control group. Multivariate analysis indicated that neoadjuvant chemoradiotherapy (NACRT) and hypoalbuminemia (B 1.6 g/dL) immediately after surgery were risk factors for IA. Among NACRT cases, hypoalbuminemia (B 1.6 g/dL) was a single risk factor. It is well known that radiation therapy leads to obstruction of lymph vessels, and inhibits wound healing and the surgically induced inflammatory response.2,3 We demonstrated that NACRT decreased the preoperative serum albumin level. In
Ó Society of Surgical Oncology 2020 First Received: 10 November 2020 Accepted: 10 November 2020 A. Tomioka, MD e-mail: [email protected]
addition, NACRT is known to make individuals prone to lymphatic leakage, and hypoalbuminemia also leads to ascites. The results of the current study suggest that lymphatic leakage and hypoalbuminemia may act synergistically and cause IA. FUTURE Recently, several studies have reported the safety and effectiveness of NACRT for pancreatic cancer, especially in cases of borderline-resectable pancreatic cancer.4,5 Although NACRT for pancreatic cancer has been performed in many institutions, it has the potential to lead to this rare but lethal complication. It is expected that further development of radiotherapy will be able to radiate tumors more selectively. Additionally, perioperative nutrition management is a well-discussed topic of digestive surgery,6 and various approaches to maintain or improve nutritional status should be attempted during neoadjuvant therapy and after surgery. DISCLOSURE interest.
The authors declare that they have no conflicts of
REFERENCES 1. Tomioka A, Shimizu T, Kagota S, et al. Association between neoadjuvant chemoradiotherapy and intractable serous ascites after pancreaticoduodenectomy for pancreatic cancer. Ann Surg Oncol. https://doi.org/10.1245/s10434-020-09401-w. 2. Jørgensen MG, Toyserkani NM, Hansen CR, et al. Quantification of chronic lymphedema in a r
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