Neurogenic diarrhoea after superior mesenteric artery divestment or resection for pancreatic adenocarcinoma following preoperative chemotherapy: international multicentre retrospective study.
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Stoop Thomas F, Croce Chiara, Ishida Hiroyuki, Ali Mahsoem, Javed Ammar A, Halimi Asif, Oba Atsushi, Groot Koerkamp Bas, Leonhardt Carl-Stephan, Thiels Cornelius A, Rangelova Elena, Sparrelid Ernesto, Sotirova Ira, Leiting Jennifer L, Tauchi Jun, Kobayashi Kosuke, Klos Marit, Beuk Lysanne P M, Genova Luana, Mastronardi Manuela, Kendrick Michael L, Mughal Nabiha A, Busch Olivier R, Franklin Oskar, Larsson Patrik, Klaiber Ulla, Schulick Richard D, Theijse Rutger T, Strobel Oliver, Ghorbani Poya, de Wilde Roeland F, Rodriguez Franco Salvador, Sugawara Toshitaka, Wilmink Johanna W, Messersmith Wells, Besselink Marc G, Wolfgang Christopher L, Inoue Yosuke, Truty Mark J, Del Chiaro Marco, International Collaboration on Advanced Pancreatic Cancer
Аннотация
METHODS: This multicentre retrospective study included consecutive patients undergoing pancreatic adenocarcinoma resection, including SMA divestment/resection, after preoperative chemotherapy with or without radiotherapy between 2016 and 2022. Primary endpoints were the incidence of postoperative neurogenic diarrhoea, associated factors, treatment strategies, and outcomes. Secondary endpoints were the rate of adjuvant chemotherapy and the impact of neurogenic diarrhoea on overall survival (OS).
RESULTS: Overall, 291 patients who underwent pancreatic resection with concomitant SMA divestment (240, 82%) or resection (51, 18%) were included in the study. Postoperative neurogenic diarrhoea was diagnosed in 193 patients. The adjusted risk of developing neurogenic diarrhoea was 59% (95% confidence interval (c.i.) 46 to 73) after ≤ 180° SMA divestment, 80% (95% c.i. 67 to 93) after > 180° SMA divestment, and 77% (95% c.i. 66 to 88) after SMA resection. Postoperative neurogenic diarrhoea was treated with non-opioid drugs (29, 15%), non-opium opioids (140, 73%), opium tincture (69, 36%), and/or octreotide (49, 25%), and normalized in 51% of patients. After adjusting for confounders, neurogenic diarrhoea was not significantly associated with OS (hazard ratio 0.83; 95% c.i. 0.55 to 1.25).
CONCLUSION: Neurogenic diarrhoea occurred in two-thirds of patients following resection of pancreatic adenocarcinoma with concomitant SMA divestment/resection, particularly after > 180° SMA divestment or SMA resection. Although challenging to manage, neurogenic diarrhoea is not associated with impaired OS. Evidence-based treatment strategies are needed for adequate management.