• Jelle C van Dongen, Mustafa Suker, Eva Versteijne, Bert A Bonsing, MieogJ Sven DJSDDepartment of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Judith de Vos-Geelen, Erwin van der Harst, Gijs A Patijn, Ignace H de Hingh, Sebastiaan Festen, Albert J Ten Tije, Olivier R Busch, Marc G Besselink, Geertjan van Tienhoven, KoerkampBas GrootBGDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., and Dutch Pancreatic Cancer Group.
• Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
• Ann. Surg. 2022 May 1; 275 (5): 979-984.

ObjectivesTo investigate the effect of preoperative chemoradiotherapy on surgical complications in patients after pancreatic resection for (borderline-)resectable pancreatic cancer.Summary Of Background DataPreoperative chemoradiotherapy is increasingly used in patients with (borderline-)resectable pancreatic cancer. concerns have been raised about the potential harmful effect of any preoperative therapy on the surgical complication rate after pancreatic resection.MethodsAn observational analysis was performed within the multicenter randomized controlled PREOPANC trial (April 2013-July 2017). The trial randomly assigned (1:1) patients to preoperative chemoradiotherapy followed by surgery and the remaining adjuvant chemotherapy or to immediate surgery, followed by adjuvant chemotherapy. The main analysis consisted of a per-protocol approach. The endpoints of the present analyses were the rate of postoperative complications.ResultsThis study included 246 patients from 16 centers, of whom 66 patients underwent resection after preoperative therapy and 98 patients after immediate surgery. No differences were found regarding major complications (37.9% vs 30.6%, P=0.400), postpancreatectomy hemorrhage (9.1% vs 5.1%, P=0.352), delayed gastric emptying (21.2% vs 22.4%, P=0.930), bile leakage (4.5% vs 3.1%, P=0.686), intra-abdominal infections (12.1% vs 10.2%, P=0.800), and mortality (3.0% vs 4.1%, P=1.000). There was a significant lower incidence of postoperative pancreatic fistula in patients who received preoperative chemoradiotherapy (0% vs 9.2%, P=0.011).ConclusionsPreoperative chemoradiotherapy did not increase the incidence of surgical complications or mortality and reduced the rate of postoperative pancreatic fistula after resection in patients with (borderline-)resectable pancreatic cancer.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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