Complications following upfront pancreatectomy with venous resection do not compromise adjuvant chemotherapy delivery and survival in pancreatic cancer

Purpose: The combined burden of vascular resections and pancreas-specific complications may preclude or delay adjuvant chemotherapy and impair survival. We evaluated the effect of complications on adjuvant therapy delivery and survival after upfront pancreatectomy with venous resection (PVR). Methods: Patients undergoing upfront PVR were retrieved from a prospectively maintained database at two high-volume Institutions. The incidence and severity of complications were correlated with administration of adjuvant chemotherapy and overall survival. Results: Overall, 280 patients underwent upfront PVR. 75% (N = 210) underwent pancreatoduodenectomy (PD), 15% (N = 41) distal pancreatectomy (DP), and 10% (N = 29) total pancreatectomy (TP). Major morbidity occurred in 34% (N = 96), with 4% (N = 12) 90-day mortality. Overall rates of POPF, PPH, and DGE were 22%, 15%, and 18%, respectively. Mortality was higher in Type IV venous resections (14%, p = 0.028). DP was associated with higher morbidity but similar mortality compared to PD and TP. The only factor independently associated with adjuvant chemotherapy delivery, administered in 196 (70%), was ASA score < 3 (p = 0.003). Factors independently associated to worse OS were age > 75 years, TP, pT > 2, pN2, and lack of adjuvant chemotherapy delivery. Conclusions: Upfront PVR has an acceptable risk profile and oncologic outcomes when adjuvant chemotherapy is administered. Survival and the delivery of adjuvant therapy do not appear to be negatively affected by complications.