Association Between Neoadjuvant Chemoradiotherapy and Intractable Serous Ascites After Pancreaticoduodenectomy for Pancr
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Association Between Neoadjuvant Chemoradiotherapy and Intractable Serous Ascites After Pancreaticoduodenectomy for Pancreatic Cancer Atsushi Tomioka, MD, Tetsunosuke Shimizu, MD, PhD, Shuji Kagota, MD, PhD, Kohei Taniguchi, MD, PhD, Koji Komeda, MD, PhD, Mitsuhiro Asakuma, MD, PhD, Fumitoshi Hirokawa, MD, PhD, and Kazuhisa Uchiyama, MD, PhD General and Gastroenterological Surgery, Osaka Medical College Hospital, Takatsuki City, Osaka, Japan
ABSTRACT Background. Intractable serous (not chylous) ascites (IA) that infrequently develops early following pancreaticoduodenectomy (PD) for pancreatic cancer is a lifethreatening problem. The relationship between neoadjuvant chemoradiotherapy (NACRT) for pancreatic cancer and the incidence of IA following PD has not been evaluated. This study aims to identify the risk factors associated with IA that develops early after PD for pancreatic cancer. Methods. We retrospectively identified 94 patients who underwent PD for pancreatic cancer at the Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan, from April 2012 to March 2020. Data on 29 parameters were obtained from medical records. Univariate and multivariate analyses were conducted to identify independent risk factors. Levels of serum albumin were compared before and after NACRT to analyze its effect. Survival analysis was also conducted. Results. Of the 92 patients included in this study, 8 (8.70%) were categorized into the IA group. Multivariate analysis identified NACRT [odds ratio (OR) 27, 95% confidence interval (CI) 1.87–394, p = 0.016)] and hypoalbuminemia (B 1.6 g/dl) just after the operation (OR 50, 95% CI 1.68–1516, p = 0.024) as risk factors. The level of serum albumin was significantly decreased following
Ó Society of Surgical Oncology 2020 First Received: 8 September 2020 Accepted: 5 November 2020 A. Tomioka, MD e-mail: [email protected]
NACRT. The IA group had poorer prognosis than the control group. Conclusions. IA is a serious problem that aggravates patient’s prognosis. Postoperative lymphatic leak might be a trigger of IA. NACRT was a major risk factor, followed by hypoalbuminemia caused by various reasons. These factors may act synergistically and cause IA.
Intractable serous (not chylous) ascites (IA) infrequently develops early following pancreaticoduodenectomy (PD) for pancreatic cancer. It is caused by lymphorrhea, malnutrition, peritonitis carcinomatosa, etc. In particular, IA without peritoneal dissemination is a serious problem. It is associated with an overall decline in quality of life and poor prognosis of patients, causing dehydration, weight loss, immunosuppression, or even death secondary to sepsis. However, adjuvant chemotherapy cannot be initiated. Previous research has documented the risk factors for chylous ascites that develops following major abdominal surgery.1 Moreover, it has been reported that the incidence of chylous ascites ranges from 1.0 to 11% in the case of pancreatic surgery.1 Studies
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