Abstract
Background: Tumor differentiation affects local invasion and patient survival in many cancers. The impact of pancreatic ductal adenocarcinoma (PDAC) differentiation on patterns of recurrence and complications following preoperative therapy and pancreatectomy is poorly defined. Methods: A retrospective analysis of a prospectively maintained database was conducted of all patients who underwent pancreatectomy for PDAC from 2011–2015 following preoperative therapy (chemotherapy, radiation, or combination). Differences in clinicopathologic characteristics, operative details, perioperative complications, overall (OS) and recurrence-free survival (RFS) were compared between patients stratified by tumor differentiation (moderate or poor). Results: Among 156 pancreatectomy patients, 112 (72%) had moderately differentiated (MD) tumors and 44 (28%) poorly differentiated (PD) tumors. The groups had similar demographics, median CA19-9, co-morbidity index, and type of preoperative therapy. Tumor size, T and N stage, lymph node ratio, and incidence of lymphovascular invasion were similar, while perineural invasion was more common in PD than MD tumors(91% vs 76%, p = 0.03). There were no differences in the incidence of Clavien-Dindo grade III/IV complications, rates of grade B or C post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in median OS (32 vs 48 months, p = 0.86), median RFS(16 vs 36 months, p = 0.17), or patterns of recurrence (local, regional, or distant) between MD and PD tumors. Conclusions: Poorly differentiated PDAC is characterized by more frequent or persistent perineural invasion relative to moderately differentiated tumors following preoperative therapy. However, tumor differentiation has no impact on postoperative patterns of local or distant tumor recurrence or the incidence or severity of post-operative complications.Tabled 1Complications Table
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