Short- and Long-Term Outcomes after Pancreatectomy for Pancreatic Cancer in Patients with Prior Esophagectomy for Esophageal Cancer.

[BACKGROUND] Resection of pancreatic ductal adenocarcinoma (PDAC) after prior esophagectomy for esophageal cancer is technically demanding and its oncologic value is unclear. We evaluated the peri-operative safety and long-term survival after pancreatectomy for PDAC in this setting.

[METHODS] All patients undergoing pancreatectomy for PDAC at Kobe University Hospital (2017-2024) were reviewed. Outcomes in patients with previous esophagectomy for esophageal cancer were compared with those in patients undergoing contemporaneous resectable PDAC without such history. Primary endpoints were postoperative morbidity/mortality and overall survival.

[RESULTS] Of 415 pancreatectomies, nine (2.2%) had a history of esophagectomy for esophageal cancer (pancreaticoduodenectomy five; distal pancreatectomy four). Preservation of the gastrointestinal-conduit vessels was achieved in seven patients; two required right gastroepiploic artery and vein reconstruction. Major morbidity occurred in one patient (11.1%); there was no 90-day mortality and no conduit-related complication. However, only three patients (33.3%) received adjuvant chemotherapy. Median overall survival was significantly shorter in post-esophagectomy patients (n = 9) than in controls (n = 249) (8.4 vs. 41.7 months, p = 0.001). Survival after pancreaticoduodenectomy was especially poor (7.4 vs. 47.2 months, p < 0.001), whereas outcomes after distal pancreatectomy did not differ (16.4 vs. 38.9 months, p = 0.781).

[CONCLUSIONS] Pancreatectomy after esophagectomy can be performed safely, even with minimally invasive techniques, yet long-term survival remains dismal, particularly after pancreaticoduodenectomy. Careful patient selection with specific attention to the feasibility of delivering perioperative chemotherapy may be required to improve outcomes in this highly selected cohort.