Long-Term Survival After Pancreatoduodenectomy for Pancreatic Adenocarcinoma
Top Cited Papers
- 1 March 2008
- journal article
- Published by Wolters Kluwer Health in Annals of Surgery
- Vol. 247 (3), 456-462
- https://doi.org/10.1097/sla.0b013e3181613142
Abstract
To determine long-term survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma and to identify clinical factors associated with long-term survival. The prognosis for long-term survival even after potentially curative resection for pancreatic adenocarcinoma is thought to be poor. Clinical factors determining short-term survival after pancreatic resection are well studied, but prognostic factors predicting long-term survival with a potential for cure are poorly understood. A case-control study was conducted of 357 patients who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma between 1981 and 2001. Histologic specimens were reanalyzed to confirm diagnosis. Follow-up was at least 5 years or until death. There was an improved survival throughout the observation period (P = 0.004). We found 62 actual 5-year survivors of whom 21 patients survived greater than 10 years, for a 5- and 10-year survival rate of 18% and 13%, respectively. Cohort analysis comparing patients with short-term ( or =5 years, n = 62) survival showed that more advanced disease (greatest tumor diameter, lymph node metastasis) and decreased serum albumin concentration were unfavorable for long-term survival (all P < 0.05). In contrast, the extent of resection and more aggressive histologic features did not correlate with long-term survival (all P > 0.05). En-bloc resection (P = 0.005) but not resection margin status (P > 0.05) was associated with long-term survival. Adjuvant chemoradiation therapy did not significantly influence long-term survival. Multivariate analysis identified lymph node status (OR 0.36, 95% CI 0.14-0.89, P = 0.03) as a prognostic factor for long-term survival. Five-year survival was no guarantee of cure because 16% of this subset died of pancreatic cancer up to 7.8 years after operation. Pancreatoduodenectomy for adenocarcinoma in the head of pancreas can provide long-term survival in a subset of patients, particularly in the absence of lymph node metastasis. One of 8 patients can achieve 10-year survival with a potential for cure.Keywords
This publication has 18 references indexed in Scilit:
- Cancer Statistics, 2007CA: A Cancer Journal for Clinicians, 2007
- 1423 Pancreaticoduodenectomies for Pancreatic Cancer: A Single-Institution ExperienceJournal of Gastrointestinal Surgery, 2006
- Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-upSurgery, 2006
- Analysis of Long-term Survivors After Surgical Resection for Pancreatic CancerPancreas, 2006
- PancreaticoduodenectomyArchives of Surgery, 2004
- Prognostic factors in resected pancreatic adenocarcinoma: Analysis of actual 5-year survivors1Journal of the American College of Surgeons, 2004
- Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinomaBritish Journal of Surgery, 2004
- Long‐term Results of Partial Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreatic Head: 25‐Year ExperienceWorld Journal of Surgery, 2003
- Results of 1001 Pancreatic Resections for Invasive Ductal Adenocarcinoma of the PancreasArchives of Surgery, 1997
- Long-Term Survival After Resection for Ductal Adenocarcinoma of the Pancreas Is It Really Improving?Annals of Surgery, 1995