Improvement of surgical and survival outcomes of patients with pancreatic cancer who underwent pancreaticoduodenectomy: a Chinese experience.
ABSTRACT To analyze our experience and the surgical and survival outcomes of patients with pancreatic carcinoma who underwent pancreaticoduodenectomy (PD) by analysis of a retrospective cohort of 205 patients over a 10 years period.
The patients were categorized into two 5-year periods: period 1, from 2000 January 1 to 2004 December 31(group 1, n = 48) and period 2, from 2005 January 1 to 2009 December 31(group 2, n = 157). We analysis the data using statistical software and find the improvement of surgical and survival outcomes of PD for pancreatic cancer in the past 10 years.
The two groups have similar age, sex distribution, comorbidity, preoperative serum tumor markers, patients number of preoperative biliary drainage and postoperative chemotherapy. More patients in group 2 underwent lymph nodes dissection (P = 0.031). And patients of group 2 had a better surgical outcomes and longer 5-year overall survival (8% vs. 19%, P = 0.036). The blood loss volume, transfusion volume, and the number of patients need blood transfusion were significantly fewer (P < 0.001) for the patients in group 2, however, the operation time was obviously lengthened (P = 0.002). Patients in Group 1 suffered more postoperative complications than those of the patients in group 2 (P = 0.021). A significant difference was reached for survival between the two group (P = 0.036).
A significant improvement of surgical and survival outcomes after PD for pancreatic cancer patients was achieved in the past 10 years. PD remains the only treatment option that potentially provides a cure for pancreatic head cancer, and postoperative chemotherapy may produce survival benefit.
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ABSTRACT: Pancreatic cancer is a devastating disease with dismal prognosis. Large population-based evidence on its survival rate and influence factors is lacking in China. This study aimed to depict the demographic factors, tumor characteristics, incidence rate and survival rate of pancreatic cancer cases in urban China. The demographic factors, tumor characteristics were collected for all the pancreatic cancer cases identified during 2004 to 2009 from the Shanghai Cancer Registry. The survival time was ascertained through linkage of the Shanghai Cancer Registry and the Shanghai Vital Statistics Registry. The deadline of death certificates was the end of December 2012. Kaplan-Meier method and Cox proportional-hazards regression model were used to explore the survival rate and influence factors. 11,672 new pancreatic cancer cases were identified among Shanghai residency during 2004 to 2009. The crude incidence rate of pancreatic cancer was increasing from 12.80/100,000 in 2004 to 15.66/100,000 in 2009, while the standardized incidence rate was about 6.70/100,000 and didn't change a lot. The overall 5-year survival rate was 4.1% and the median survival time was 3.9 (95% Confidence Interval (CI) 3.8-4.0) months. Subjects had received surgical resection had improved survival (HR = 0.742, 95% CI: 0.634-0.868) than its counterparts. In adjusted multivariable Cox proportional-hazard models, factors associated with poor survival included older age at diagnosis (age > = 70 years: hazard ratio (HR) = 1.827, 95% CI: 1.614-2.067), male sex (HR = 1.155, 95% CI: 1.041-1.281), distant disease at diagnosis (HR = 1.257, 95% CI: 1.061-1.488), positive lymph node (HR = 1.236, 95% CI: 1.085-1.408), tumor stage (Stage IV HR = 2.817, 95% CI: 2.029-3.909). The age-adjusted incidence rate was stable and overall survival rate was low among pancreatic cancer patients of Shanghai residency. Early detection and improved treatment strategies are needed to improve prognosis for this deadly disease.PLoS ONE 10/2013; 8(10):e76052. DOI:10.1371/journal.pone.0076052 · 3.23 Impact Factor
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ABSTRACT: Background To explore the feasibility, safety and indications of the modified Appleby operation for carcinoma of the body and tail of the pancreas and to identify prognostic factors. Material and Methods Data from a total of 15 patients receiving the modified Appleby operation in our department were retrospectively analyzed. Correlation analyses and univariate and multivariate analyses of the survival time were performed to identify prognostic factors. Results The operations were successful in all 15 patients. The median survival time was 19 months except in one case, where the patient died; and the 1- and 3-year survival rates were 86.7% (13/15) and 6.7% (1/15), respectively. A positive correlation was found between age and survival time (P=0.037, Pearson Correlation=0.541). In addition, univariate analysis, age, operative time and perineural invasion were correlated with survival time (P = 0.029, 0.035, and 0.049, respectively). Finally, multivariate analysis revealed that only age ≥ 60 y was correlated with survival (HR = 0.263, P = 0.044). Conclusions The improved Appleby operation was feasible and safe when performed in experienced centers by experienced surgeons and can improve the patients’ survival time and quality of life. Statistical analysis suggests that elderly patients may have a better prognosis than younger patients to some extent.Journal of Surgical Research 09/2014; 194(1). DOI:10.1016/j.jss.2014.09.014 · 2.12 Impact Factor
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ABSTRACT: Prognosis of locally advanced pancreatic head carcinoma after Whipple remains poor. This study is to investigate the efficacy and safety of regional lymphadenectomy and chemotherapy of isolated hypoxic perfusion (IHP) via dual-route, and to analyze the effect for survival period. Consecutive patients subjected to our department from January 1, 2006 to December 31 2011 for locally advanced pancreatic head carcinoma were prospectively divided into two groups according to therapeutic modality, and clinical and follow-up data was recorded. In study group, operation duration and postoperative stay time were shorter, blood loss and blood transfusion were less, and incidence of complications was lower. The mean and median survival time was 17.4 ± 0.76 months and 18.0 months in study group, longer than control group of 14.1 ± 0.85 months and 17.6 months. Regional lymphadenectomy can be performed with low mortality and morbidity, and combined postoperative IHP via dual-route can improve survival time.International Journal of Clinical and Experimental Medicine 01/2015; 8(4):6463-71. · 1.42 Impact Factor