Impact of neoadjuvant therapy on short-term outcomes after left pancreatectomy: A propensity score–matched international multicenter study

Background: Neoadjuvant therapy is protective of postoperative pancreatic fistula in pancreatoduodenectomy. However, the effect of neoadjuvant therapy after left pancreatectomy remains unclear. The aim of this international multicenter study was to evaluate the impact of neoadjuvant therapy on short term outcomes after left pancreatectomy for pancreatic ductal adenocarcinoma. Methods: Patients undergoing left pancreatectomy from January 2010 to April 2023 at 9 high-volume centers were included. Patients treated with neoadjuvant therapy were compared to patients with upfront surgery. Propensity score matching in 1:1 fashion was used. The primary outcome was postoperative pancreatic fistula. Results: Six-hundred-fifty patients underwent resection due to pancreatic ductal adenocarcinoma, of which 70 patients (10.8%) received neoadjuvant therapy. In the matched cohort (upfront surgery, 66 patients; neoadjuvant therapy, 66 patients), the rate of postoperative pancreatic fistula was similar in patients undergoing upfront surgery versus patients receiving neoadjuvant therapy (16 [24.2%] vs 13 [19.7%], P = .674, respectively). No statistically significant differences were observed between neoadjuvant therapy and upfront surgery group with respect to grade C-POPF, readmission, reoperation, postpancreatectomy hemorrhage, 90-day mortality, and severe complications. Conclusion: Neoadjuvant therapy was not associated with decreased rate of postoperative pancreatic fistula in patients undergoing left pancreatectomy.