Predictors of Early Mortality After Surgical Resection of Pancreatic Adenocarcinoma in the Era of Neoadjuvant Treatment

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Abstract

Objectives

Neoadjuvant treatments are increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC), yet some experience early mortality after resection. We sought to identify predictors of early mortality after PDAC resection and determine their interaction with neoadjuvant therapy.

Methods

We performed a retrospective study of patients with PDAC resection from March 2011 to March 2014. We compared those who died within one year after surgery to those living beyond 1 year, and those who received neoadjuvant therapy to those taken directly to surgery. We used logistic regression to identify predictors of early mortality and determine their interaction with neoadjuvant therapy.

Results

Of 191 patients who underwent resection, 59 (30.9%) died within 1 year and 79 (41.4%) received neoadjuvant therapy. Early mortality patients were older, with higher comorbidity, and more likely to have lymph node positivity. Patients receiving neoadjuvant therapy were younger, with lower comorbidity, and more likely to have upfront unresectable disease. Predictors of early mortality included: higher comorbidity, poorly differentiated tumor grade, and lymph node positivity. We found that neoadjuvant therapy moderated the effects of comorbidity and lymph node positivity on early mortality risk.

Conclusions

We identified predictors of early mortality after PDAC resection and determined their interaction with neoadjuvant therapy.

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