Understanding futility in pancreaticoduodenectomy: Insights from a national cohort

Author:

Marcinak Clayton T.1ORCID,Ahmed Kaleem S.1ORCID,LoConte Noelle K.2,Praska Corinne E.1,Varley Patrick R.1,Weber Sharon M.,Abbott Daniel E.1ORCID,Ronnekleiv‐Kelly Sean M.1,Kratz Jeremy D.2,Lubner Sam J.2,Minter Rebecca M.1,Zafar Syed Nabeel1

Affiliation:

1. Division of Surgical Oncology, Department of Surgery, School of Medicine and Public Health University of Wisconsin–Madison Madison Wisconsin USA

2. Division of Hematology, Oncology, and Palliative Care, Department of Medicine, School of Medicine and Public Health University of Wisconsin–Madison Madison Wisconsin USA

Abstract

AbstractBackground and ObjectivesPancreaticoduodenectomy (PD), the only surgical option for right‐sided pancreatic ductal adenocarcinoma (PDAC), carries significant morbidity. Not all patients may be deriving a survival benefit from this operation. We sought to identify the rate of futile PD and its associated factors in a large national cohort.MethodsWe performed a retrospective analysis using the National Cancer Database (2004–2020), including all patients who underwent PD for non‐metastatic PDAC. The primary outcome was operative futility, which was defined as death within 12 months of diagnosis despite PD. Multivariable regression was used to identify factors associated with futility. We performed a subgroup analysis on patients who received neoadjuvant systemic therapy.ResultsData from 66 326 patients were analyzed, and 16 772 (25.3%) underwent PD that met criteria for futility. Macroscopically positive margins (odds ratio [OR]: 2.87; 95% confidence interval [CI]: 2.36–3.48), poor tumor differentiation (OR: 2.44; 95% CI: 2.25–2.65), and N2 nodal stage (OR: 2.09; 95% CI: 1.98–2.20) were associated with the greatest odds of futility. Meanwhile, receipt of any systemic therapy (OR: 0.33; 95% CI: 0.31–0.34), receipt of any radiation (OR: 0.60; 95% CI: 0.57–0.63), and receipt of neoadjuvant systemic therapy (OR: 0.62; 95% CI: 0.57–0.66) were associated with the lowest odds of futility. In the neoadjuvant subgroup, a longer diagnosis‐to‐surgery interval was associated with lower odds of futility.ConclusionPD was futile in about one quarter of patients. Futility was associated with higher age and worse tumor biology. Receipt of neoadjuvant therapy resulted in fewer futile operations.

Funder

National Cancer Institute

National Human Genome Research Institute

Publisher

Wiley

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