• Catherine H Davis, Simone Augustinus, Nine de Graaf, Ulrich F Wellner, Karin Johansen, Bodil Andersson, Joal D Beane, Bergthor Björnsson, Olivier R Busch, Elizabeth M Gleeson, Hjalmar C van Santvoort, Bobby Tingstedt, Caroline Williamsson, Tobias Keck, Marc G Besselink, KoerkampBas GrootBGDepartment of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands (Koerkamp)., Henry A Pitt, and Global Audits on Pancreatic Surgery Group (GAPASURG).
• From the Department of Surgery, Baylor Scott & White Health, Dallas, TX (Davis).
• J. Am. Coll. Surg. 2024 Apr 1; 238 (4): 613621613-621.

BackgroundThe introduction of modern chemotherapy a decade ago has led to increased use of neoadjuvant therapy (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC). A recent North American study demonstrated increased use of NAT and improved operative outcomes in patients with PDAC. The aims of this study were to compare the use of NAT and short-term outcomes in patients with PDAC undergoing pancreatoduodenectomy (PD) among registries from the US and Canada, Germany, the Netherlands, and Sweden.Study DesignDatabases from 2 multicenter (voluntary) and 2 nationwide (mandatory) registries were queried from 2018 to 2020. Patients undergoing PD for PDAC were compared based on the use of upfront surgery vs NAT. Adoption of NAT was measured in each country over time. Thirty-day outcomes, including the composite measure (ideal outcomes), were compared by multivariable analyses. Sensitivity analyses of patients undergoing vascular resection were performed.ResultsOverall, 11,402 patients underwent PD for PDAC with 33.7% of patients receiving NAT. The use of NAT increased steadily from 28.3% in 2018 to 38.5% in 2020 (p < 0.0001). However, use of NAT varied widely by country: the US (46.8%), the Netherlands (44.9%), Sweden (11.0%), and Germany (7.8%). On multivariable analysis, NAT was significantly (p < 0.01) associated with reduced rates of serious morbidity, clinically relevant pancreatic fistulae, reoperations, and increased ideal outcomes. These associations remained on sensitivity analysis of patients undergoing vascular resection.ConclusionsNAT before PD for pancreatic cancer varied widely among 4 Western audits yet increased by 26% during 3 years. NAT was associated with improved short-term outcomes.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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