ASO Author Reflections: Exploring the Oncologic Impact of Pancreatic Fistula after Distal Pancreatectomy for Ductal Aden
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Exploring the Oncologic Impact of Pancreatic Fistula after Distal Pancreatectomy for Ductal Adenocarcinoma Piera Leon, MD
, and Fabrizio Panaro, MD, PhD
Department of Surgery, Division of HBP Surgery and Transplantation, Saint Eloi Montpellier University Hospital, Montpellier, France
PAST While the negative consequences of postoperative pancreatic fistula (POPF) on short-term outcomes after pancreatic surgery for cancer have been clearly demonstrated, the impact of POPF on overall survival (OS), and diseasefree survival (DFS) has been poorly explored. Recent evidences,1–3 among other discordant findings, suggests that POPF may also play a role in pancreatic cancer recurrence. Actually, POPF is the most common complication after distal pancreatectomy (DP), occurring in up to 65% of patients, and survival after curative resection for left pancreatic cancer is particularly poor with high reported recurrence rate.4 PRESENT To explore the oncologic impact of POPF, we strictly selected patients undergoing curative distal pancreatectomy (DP) for ductal adenocarcinoma (PDAC) of the body and tail of the pancreas. We retrospectively examined the data of 283 adult patients from prospectively collected databases from 12 European surgical departments.5 We compared patients who presented or not clinically relevant (CR-)POPF. Although poorer in the POPF group, overall survival (OS) and disease-free survival (DFS) did not significantly differ between the patients with or without CR-
Ó Society of Surgical Oncology 2020 First Received: 19 October 2020 Accepted: 19 October 2020 P. Leon, MD e-mail: [email protected]
POPF. Compared to those who had no CR-POPF, fewer patients benefited from adjuvant chemotherapy after CRPOPF (76.2% versus 83.8%) but the difference was not significant (p = 0.228). Therefore, CR-POPF did not substantially affect the postoperative therapeutic course nor oncologic long-term outcomes in our series. Moreover, CR-POPF was not a predictive factor for disease recurrence nor associated with increased incidence of peritoneal or local relapse.5 FUTURE Future prospective trials are needed to confirm these results and others to assess this issue for pancreatic head cancers. Lowering the CR-POPF rate could have only a marginal effect in improving survival of patients with PDAC after curative DP. DISCLOSURES
The author declares no source of support.
REFERENCES 1. Serrano PE, Kim D, Kim PT, et al. Effect of pancreatic fistula on recurrence and long-term prognosis of periampullary adenocarcinomas after pancreaticoduodenectomy. Am Surg. 2016;82(12):1187–1195. 2. Dundar HZ, Tasar P, Isik O, et al. Anastomotic leaks at the pancreaticojejunostomy following pancreaticoduodenectomy in patients with pancreatic head adenocarcinoma increases the local recurrence rate. Ann Ital Chir. 2018;89:315–319. 3. Nagai S, Fujii T, Kodera Y, et al. Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol. 2011;18(8):2329–37. https://doi.org/1
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