Long Term and Oncologic Outcomes for Patients Receiving Piperacillin-Tazobactam or Cefoxitin as Antibiotic Prophylaxis for Pancreatoduodenectomy.

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Journal: Annals of surgery

Study question
Does using broad-spectrum perioperative prophylaxis with piperacillin-tazobactam (PTZ), compared with cefoxitin, during pancreatoduodenectomy influence long-term oncologic outcomes, including adjuvant chemotherapy use and survival?

Design and data source

  • Registry-linked analysis of a prior randomized clinical trial comparing PTZ vs cefoxitin for surgical site infection (SSI) prevention in pancreatoduodenectomy.
  • Data linkage: Trial participants from the ACS NSQIP database were linked to the National Cancer Database to assess oncologic outcomes.
  • Statistical methods (chemotherapy): Multivariable logistic regression evaluated factors associated with delivery of indicated adjuvant chemotherapy.
  • Statistical methods (survival): Survival was assessed using Kaplan–Meier and Cox proportional hazards models.

Cohort

  • Original trial size: 778 patients.
  • Eligible for linkage: 471 patients treated at Commission on Cancer–accredited centers.
  • Successfully matched: 426 patients total
    • PTZ group: 203 patients.
    • Cefoxitin group: 223 patients.

Key findings

  • Adjuvant chemotherapy omission among those with an indication:
    • PTZ: 9.4%
    • Cefoxitin: 15.4% (P = 0.097)
  • Factors not significantly associated with receipt of indicated adjuvant chemotherapy:
    • PTZ vs cefoxitin: OR 1.49; 95% CI 0.56–3.95
    • Presence of SSI: OR 0.58; 95% CI 0.21–1.65
  • Survival impact: Postoperative SSI was associated with significantly worse 3‑year overall survival (HR 1.69; 95% CI 1.20–2.38).

Interpretation for practice

  • Antibiotic choice: Broad-spectrum prophylaxis with PTZ, while previously shown to reduce SSI, did not significantly alter the delivery of indicated adjuvant chemotherapy or other measured oncologic care processes.
  • Impact of complications: Occurrence of SSI itself is associated with worse long-term survival after pancreatoduodenectomy, reinforcing the importance of preventing perioperative complications in oncologic surgery.
  • Methodologic value: The study also demonstrates the value of linking clinical trial data with cancer registries to evaluate long-term oncologic outcomes.

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