Association between preoperative statin use and survival after pylorus-preserving pancreaticoduodenectomy for pancreatic or periampullary cancer: a propensity score-matched cohort study.

BACKGROUND: Beyond their primary lipid-lowering role, statins exert pleiotropic properties such as anti-inflammatory and endothelial-stabilizing effects. In this study, we investigated whether preoperative statin exposure was associated with postoperative survival outcomes and disease-free survival (DFS) in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD) for pancreatic or periampullary malignancies. METHODS: We retrospectively analyzed patients who underwent PPPD at a tertiary center between 2012 and 2016. Short-term (1-year) and long-term outcomes, including 5-year mortality, overall mortality, and DFS, were compared between statin users and nonusers. To minimize baseline imbalance, 1:2 propensity score (PS) matching was performed using a model that incorporated demographic, clinical, and major pathologic prognostic factors, including age, sex, comorbidities, tumor location, tumor-node-metastasis (TNM) stage, resection margin status, lymph-node ratio, tumor grade, and carbohydrate antigen 19-9 (CA19-9). Cox proportional hazards regression was used to assess associations between statin use and outcomes. RESULTS: Among 718 patients, 130 (18.1%) received preoperative statins. After 1:2 matching, 116 statin users and 193 nonusers were analyzed. One-year, 5-year, and overall mortality did not differ significantly between groups before or after matching, and preoperative statin use was not independently associated with 5-year or overall mortality [5-year mortality: adjusted hazard ratio (HR), 0.96, 95% confidence interval (CI), 0.72-1.27; PS-matched HR, 1.09, 95% CI, 0.80-1.49]. Although a lower 1-year mortality was observed after multivariable adjustment, this association was not significant in the crude or PS-matched analyses. DFS likewise showed no significant difference at any outcome in either unadjusted or adjusted analyses. CONCLUSIONS: Preoperative statin use was not associated with short-term or long-term survival or oncologic outcomes after PPPD.