ASSOCIATION OF TIMING OF ADJUVANT CHEMOTHERAPY WITH SURVIVAL OUTCOME IN PATIENTS WITH WHIPPLE FOR PERIAMPULLARY ADENOCARCINOMA

Abstract

Background: Periampullary adenocarcinoma is a rare gastrointestinal malignancy for which surgical resection remains the primary curative approach. Despite surgery, recurrence rates remain high, and adjuvant chemotherapy is commonly recommended. However, the optimal timing for initiating chemotherapy after pancreaticoduodenectomy remains uncertain, particularly in low- and middle-income settings where postoperative recovery and healthcare access may influence treatment delays.

Objective: To evaluate the association between the timing of adjuvant chemotherapy initiation and survival outcomes in patients undergoing the Whipple procedure for periampullary adenocarcinoma.

Methods: A retrospective observational study was conducted over a one-year period at a tertiary care hospital in Rawalpindi. Forty patients with histopathologically confirmed periampullary adenocarcinoma who underwent pancreaticoduodenectomy and received adjuvant chemotherapy were included. Patients with metastatic disease, incomplete medical records, or no adjuvant therapy were excluded. Data were retrieved from the Hospital Management System and included demographic variables, comorbidities, tumor characteristics, treatment details, and survival outcomes. Patients were categorized based on chemotherapy initiation timing (<8 weeks, 8–12 weeks, and >12 weeks). Survival analysis was performed using Kaplan–Meier curves, and multivariate regression analysis was applied to identify factors associated with delayed chemotherapy initiation. Statistical analyses were conducted using SPSS version 26, with significance set at p<0.05.

Results: Among the study population, 40% initiated adjuvant chemotherapy within 8 weeks, 22.5% between 8–12 weeks, and 37.5% after 12 weeks following surgery. Patients who started chemotherapy within 8 weeks demonstrated the highest survival probabilities across follow-up. Those initiating treatment after 12 weeks exhibited the poorest survival, with a marked decline observed during early follow-up. Multivariate analysis identified advanced age, higher Charlson–Deyo comorbidity scores, larger tumor size, and unplanned postoperative readmissions as significant predictors of delayed chemotherapy initiation.

Conclusion: Earlier initiation of adjuvant chemotherapy following pancreaticoduodenectomy was associated with superior survival outcomes in periampullary adenocarcinoma. Delays beyond twelve weeks were linked to substantially poorer prognosis, highlighting the need for timely postoperative oncology care and individualized strategies to minimize treatment delays.