Surgery · 2026
Neoadjuvant therapy in frail patients with pancreatic cancer: Impact on surgical safety and outcomes.
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Bitar Elio R, El Moheb Mohamad, Cummins Kaelyn C, Sears Olivia, Kim Susan, Shen Chengli, Ruff Samantha M, Tsung Allan
Аннотация
BACKGROUND: Frailty predicts poor outcomes after pancreatic resection, but its influence on the use, tolerability, and perioperative safety of neoadjuvant therapy among resected patients remains unclear.
METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program pancreatectomy-targeted database (2014-2023), we identified patients undergoing pancreatoduodenectomy or distal pancreatectomy for pancreatic ductal adenocarcinoma. Frailty was defined as a modified 5-factor frailty index score ≥2. Multivariable logistic regression evaluated the association between frailty and neoadjuvant therapy receipt and the effect of neoadjuvant therapy on 30-day outcomes in frail patients. Effect modification by frailty status was assessed by including an interaction term between frailty and neoadjuvant therapy.
RESULTS: Among 29,528 patients, 7,261 (24.59%) were frail, and 11,235 (38.05%) received neoadjuvant therapy. Frailty was associated with decreased neoadjuvant therapy receipt (odds ratio, 0.881; P < .001). In multivariable analyses of frail patients, neoadjuvant therapy was independently associated with lower odds of delayed gastric emptying (odds ratio, 0.855; P = .034), percutaneous drain placement (odds ratio, 0.744; P < .001), operative drain present at postoperative day 30 (odds ratio, 0.662; P < .001), respiratory events (P < .05), infectious complications (P < .05), cardiac arrest (odds ratio, 0.531; P = .010), and prolonged hospitalization (odds ratio, 0.707; P = .036) when compared with upfront resection. Interaction analyses showed that frailty did not significantly modify neoadjuvant therapy effects; however, frail patients who underwent resection appeared to derive greater benefit regarding cardiac arrest.
CONCLUSION: Frailty alone should not necessarily be considered a contraindication to neoadjuvant therapy. Among frail patients who ultimately proceed to resection, the perioperative risks of neoadjuvant therapy appear manageable.
METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program pancreatectomy-targeted database (2014-2023), we identified patients undergoing pancreatoduodenectomy or distal pancreatectomy for pancreatic ductal adenocarcinoma. Frailty was defined as a modified 5-factor frailty index score ≥2. Multivariable logistic regression evaluated the association between frailty and neoadjuvant therapy receipt and the effect of neoadjuvant therapy on 30-day outcomes in frail patients. Effect modification by frailty status was assessed by including an interaction term between frailty and neoadjuvant therapy.
RESULTS: Among 29,528 patients, 7,261 (24.59%) were frail, and 11,235 (38.05%) received neoadjuvant therapy. Frailty was associated with decreased neoadjuvant therapy receipt (odds ratio, 0.881; P < .001). In multivariable analyses of frail patients, neoadjuvant therapy was independently associated with lower odds of delayed gastric emptying (odds ratio, 0.855; P = .034), percutaneous drain placement (odds ratio, 0.744; P < .001), operative drain present at postoperative day 30 (odds ratio, 0.662; P < .001), respiratory events (P < .05), infectious complications (P < .05), cardiac arrest (odds ratio, 0.531; P = .010), and prolonged hospitalization (odds ratio, 0.707; P = .036) when compared with upfront resection. Interaction analyses showed that frailty did not significantly modify neoadjuvant therapy effects; however, frail patients who underwent resection appeared to derive greater benefit regarding cardiac arrest.
CONCLUSION: Frailty alone should not necessarily be considered a contraindication to neoadjuvant therapy. Among frail patients who ultimately proceed to resection, the perioperative risks of neoadjuvant therapy appear manageable.