Prehabilitation Targets Associated with the Omission of Adjuvant Chemotherapy After Surgery for Pancreatic Cancer

Abstract

Introduction: Curative treatment for pancreatic cancer relies on surgical resection combined with systemic chemotherapy, administered either before (neoadjuvant) or after (adjuvant) surgery. However, a considerable proportion of patients undergoing upfront resection fail to receive adjuvant chemotherapy, which negatively impacts survival. Identifying modifiable preoperative factors contributing to this omission could improve postoperative outcomes. This study investigated potential prehabilitation targets associated with the omission of adjuvant chemotherapy following pancreatic cancer surgery. Methods: We conducted a post-hoc analysis of a prospective observational cohort including all patients who underwent pancreaticoduodenectomy at the Regional Academic Cancer Centre Utrecht between 2016 and 2022. The primary outcome was omission of adjuvant chemotherapy. Associations between prehabilitation-related factors—smoking, alcohol use, nutritional status, anemia, mobility, muscle strength, mental stress, and exocrine pancreatic insufficiency—were assessed using logistic regression. As a secondary analysis, we examined the relationship between these factors and major postoperative complications, a known determinant of chemotherapy omission. Results: In total, 214 patients were included of which 115 patients (54%) were male with a median age of 70 years (± 7 years). A total of 70/214 patients (33%) did not start with adjuvant chemotherapy. Only smoking was independently associated with omitting chemotherapy (adjusted odds ratio (aOR) 2.98, 95% confidence interval (CI) 1.25–7.13, P < 0.01). Patients who suffered from major postoperative complications were less likely to receive adjuvant chemotherapy (aOR 2.36, 95%CI 1.07–5.18, P = 0.03). Again, only smoking was associated with a major postoperative complication (aOR 2.27, 95% CI 1.08–4.76). Conclusion: Smoking is a modifiable prehabilitation target linked to both omission of adjuvant chemotherapy and increased risk of major postoperative complications following pancreatic surgery.