Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1663-1672
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1663
Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss
Krist Aploks, Minha Kim, Stephanie Stroever, Alexander Ostapenko, Young Bo Sim, Ashwinkumar Sooriyakumar, Arash Rahimi-Ardabily, Ramanathan Seshadri, Xiang Da Dong
Krist Aploks, Minha Kim, Alexander Ostapenko, Young Bo Sim, Ashwinkumar Sooriyakumar, Arash Rahimi-Ardabily, Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
Stephanie Stroever, Department of Research and Innovation, Nuvance Health, Danbury, CT 06810, United States
Ramanathan Seshadri, Xiang Da Dong, Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, Danbury, CT 06810, United States
Author contributions: Aploks K, Kim M, Ostapenko A, Dong XD, and Seshadri R contributed to the conceptualization of the project; Aploks K, Stroever S, Kim M, Ostapenko A, Dong XD, and Seshadri R contributed to the methodology and validation of the data; Stroever S conducted the formal statistical analyses; Aploks K, Kim M, Sim YB, and Sooriyakumar A prepared the original manuscript; Aploks K, Kim M, Ostapenko A, Sim YB, Sooriyakumar A, Rahimi-Ardabily A, Dong XD, and Seshadri R contributed to the final draft revision and editing; Dong XD and Seshadri R supervised the project.
Institutional review board statement: Ethical review and approval were waived for this study since the data used was de-identified and obtained from a participant use data file.
Informed consent statement: This study was a retrospective review that utilized only de-identified patient data from National Cancer Database. Given this fact, no signed informed consent is needed.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Data was obtained with permission from the American College of Surgeon's National Cancer Database. NSQIP data can be obtained by visiting https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiang Da Dong, FACS, MD, Chief Doctor, Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, 95 Locust Avenue, Danbury, CT 06810, United States. eric.dong@nuvancehealth.org
Received: March 29, 2023
Peer-review started: March 29, 2023
First decision: April 26, 2023
Revised: May 12, 2023
Accepted: June 12, 2023
Article in press: June 12, 2023
Published online: August 27, 2023
ARTICLE HIGHLIGHTS
Research background

Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States. In addition to neoadjuvant chemotherapy, neoadjuvant radiotherapy may improve negative margin resection rates. This study seeks to investigate the safety and efficacy of neoadjuvant radiotherapy in patients with pancreatic adenocarcinoma.

Research motivation

By better clarifying the benefits and drawbacks that are associated with neoadjuvant radiotherapy administration in patients with pancreatic adenocarcinoma, practitioners can make informed decisions regarding its use.

Research objectives

The primary objective of the study was to investigate the effect that neoadjuvant radiotherapy has on both intra-operative and 30-d postoperative morbidities in patients with pancreatic adenocarcinoma.

Research methods

Using 2015-2019 data from the National Surgery Quality Improvement Program data set, we divided pancreatic adenocarcinoma patients into two groups based on neoadjuvant radiotherapy status. Then we performed univariable and multivariable analyses to identify differences in baseline characteristics and outcomes between the two groups.

Research results

When compared to patients with pancreatic adenocarcinoma who underwent surgical resection alone, patients who underwent neoadjuvant radiotherapy were more likely to have longer surgeries and higher perioperative blood loss. The neoadjuvant radiotherapy patients were also less likely to have organ space infections and pancreatic fistulae formation.

Research conclusions

Neoadjuvant radiotherapy has significant effects on intraoperative and 30-d postoperative morbidity in patients with pancreatic adenocarcinoma. It may make eventual surgical resection of the cancer more complex.

Research perspectives

Future research should focus on finding new methods that work to minimize the negative side effects associated with neoadjuvant radiotherapy in patients with pancreatic adenocarcinoma.