Background
Resection is the only life-prolonging option for pancreatic or periampullary cancer. Cell-me
diate
d immunity might re
duce progression of metastasis or local recurrence likelihoo
d, but surgery associate
d morbi
dity can suppress this immunity. The aim of this stu
dy was to examine the influence of complications on cancer specific survival after pancreato
duo
denectomy (PD) for pancreatic an
d periampullary cancer.
Method
517 consecutive patients who underwent PD for pancreatic or periampullary adenocarcinoma were analysed.
Results
After median follow-up of 24 (14-44) months, 377 (73%) patients had died from progressive disease, 140 (27%) were alive. Median survival for pancreatic adenocarcinoma was 22 (18-25) months following an uncomplicated postoperative course versus 16 (13-19) months for patients with major surgical complications (p聽=聽0.021). Multivariable Cox regression analysis demonstrated that microscopically residual disease (R1), complications, and adjuvant therapy were independent factors for recurrence. Within the R1 group, survival for patients with complications was even more limited, 9.7 (8.3-11.0) versus 18.7 (15.0-22.5) for those without (p聽<聽0.001). For patients with R1 resection complications was the only independent predictor for a shorter time interval to death (hazard ratio 1.96; 95% CI 1.16-3.30). Complications did not influence survival of patients with periampullary adenocarcinoma.
Conclusion
Complications after resection are independently related to an impaired survival following PD for pancreatic, but not periampullary cancer. The effect is even more dramatic in patients who had an R1 resection. Although the relation is not causal per se, the findings support the hypothesis of a complication-induced, compromised immunity rendering patients more susceptible for recurrent disease.