1023 The Changing Indication and Outcomes of Patients Undergoing Pancreatectomy for Malignancy
S Jackson, S Dreyer, A Bryce, R Thomas, F Duthie, M Coats, R Carter, C McKay, E Dickson, D Chang, D Holroyd, N Jamieson- Surgery
Abstract
Aim
Pancreatic surgery has evolved significantly in terms of indications and peri-operative management to improve long term outcomes for patients. The aim of this study is to assess the change in indication and long-term outcome for patients undergoing pancreatectomy for malignancy.
Method
Patients who underwent pancreatectomy at the West of Scotland Pancreatic Unit, Glasgow Royal Infirmary between 2000 – 2020 for malignancy were included. Clinicopathological variables, survival and recurrence data were collected from patient notes and electronic patient records.
Results
594 patients were identified. The majority were for pancreatic ductal adenocarcinoma (PDAC) n = 325 (54.7%). There was a significant increase in overall survival for all indications (28.6 months vs 41.8 months, P = 0.001), completion of adjuvant therapy and the use of neoadjuvant therapy (P<0.001) over the first and second decades in the study period. After adopting a neoadjuvant strategy for PDAC in the unit from 2013, the overall median survival increased from 24.6 months to 34.5 months (P<0.001). The overall survival for PDACs was higher for those receiving neoadjuvant chemotherapy compared to upfront resection (41.9 months vs 38.9 months, P = 0.151). For patients with PDAC who received upfront surgery, median survival increased from 24.2 to 40.3 months (P = 0.004) once a neoadjuvant strategy was adopted.
Conclusions
There has been significant changes to the indications and long-term outcomes for patients undergoing pancreatectomy. A neoadjuvant strategy improved survival even in those patients who received upfront surgery.