Publications

Authors:

Paiella, Salvatore; Malleo, Giuseppe; Lionetto, Gabriella; Cattelani, Alice; Casciani, Fabio; Secchettin, Erica; De Pastena, Matteo; Bassi, Claudio; Salvia, Roberto

Title:

Adjuvant Therapy After Upfront Resection of Resectable Pancreatic Cancer: Patterns of Omission and Use-A Prospective Real-Life Study

Year:

2024

Type of item:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Language:

Inglese

Referee:

No

Name of journal:

ANNALS OF SURGICAL ONCOLOGY

ISSN of journal:

1068-9265

Page numbers:

N/A-N/A

Keyword:

Adjuvant therapy; Failure to rescue; Pancreatic cancer; Pancreatic surgery; Postoperative complications

Short description of contents:

Background: Little is known about adjuvant therapy (AT) omission and use outside of randomized trials. We aimed to assess the patterns of AT omission and use in a cohort of upfront resected pancreatic cancer patients in a real-life scenario. Methods: From January 2019 to July 2022, 317 patients with resected pancreatic cancer and operated upfront were prospectively enrolled in this prospective observational trial according to the previously calculated sample size. The association between perioperative variables and the risk of AT omission and AT delay was analyzed using multivariable logistic regression. Results: Eighty patients (25.2%) did not receive AT. The main reasons for AT omission were postoperative complications (38.8%), oncologist's choice (21.2%), baseline comorbidities (20%), patient's choice (10%), and early recurrence (10%). At the multivariable analysis, the odds of not receiving AT increased significantly for older patients (odds ratio [OR] 1.1, p < 0.001), those having an American Society of Anesthesiologists score ≥II (OR 2.03, p = 0.015), or developing postoperative pancreatic fistula (OR 2.5, p = 0.019). The likelihood of not receiving FOLFIRINOX as AT increased for older patients (OR 1.1, p < 0.001), in the presence of early-stage disease (stage I-IIa vs. IIb-III, OR 2.82, p =0.031; N0 vs. N+, OR 3, p = 0.03), and for patients who experienced postoperative major complications (OR 4.7, p = 0.009). A twofold increased likelihood of delay in AT was found in patients experiencing postoperative complications (OR 3.86, p = 0.011). Conclusions: AT is not delivered in about one-quarter of upfront resected pancreatic cancer patients. Age, comorbidities, and postoperative complications are the main drivers of AT omission and mFOLFIRINOX non-use. Clinicaltrials registration: NCT03788382.

Product ID:

137444

Handle IRIS:

11562/1118313

Last Modified:

September 22, 2024

Bibliographic citation:

Paiella, Salvatore; Malleo, Giuseppe; Lionetto, Gabriella; Cattelani, Alice; Casciani, Fabio; Secchettin, Erica; De Pastena, Matteo; Bassi, Claudio; Salvia, Roberto, Adjuvant Therapy After Upfront Resection of Resectable Pancreatic Cancer: Patterns of Omission and Use-A Prospective Real-Life Study «ANNALS OF SURGICAL ONCOLOGY» , 2024 , pp. N/A-N/A

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