Surgical treatment of pancreatic adenocarcinoma: actual survival and prognostic factors in 343 patients

Department of Surgery, Academic Medical Center from the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
European Journal of Cancer (Impact Factor: 5.42). 04/2004; 40(4):549-58.
Source: PubMed


Survival data of patients with pancreatic carcinoma are often overestimated because of incomplete follow-up. Therefore, the aim of this study was to approach complete follow-up and to analyse survival and prognostic factors of patients who underwent surgical treatment for pancreatic adenocarcinoma. Between 1992 and 2002, 343 patients underwent surgical treatment for pancreatic adenocarcinoma. One hundred and sixty patients underwent a resection with a curative intention and 183 patients underwent bypass surgery for palliation. Follow-up was complete for 93% of patients. Median survival after resection and bypass was 17.0 and 7.5 months, and 5-year survival was 8% and 0, respectively. In multivariate analysis, tumour-positive lymph nodes, non-radical surgery, poor tumour differentiation, and tumour size were independent prognostic factors for survival after resection. For patients treated with bypass surgery, metastatic disease and tumour size independently predicted survival. In conclusion, actual survival of patients with pancreatic adenocarcinoma is disappointing compared with the actuarial survival rates reported in the literature. The independent prognostic factors for survival of patients who underwent surgical treatment for pancreatic adenocarcinoma are tumour-related.

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Available from: Dirk J Gouma, Mar 24, 2015
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    • "Most of them are pancreatic adenocarcinomas, with a poor overall five-year survival, varying from 8% for stage I to 3% for stage IV [3]. It is noticeable that the survival of such patients has barely improved over the last years, despite all efforts at providing a more effective therapy [4,5]. In most cases (85%), the disease has already reached an incurable state at the time of diagnosis, due to extensive local disease or metastases, making an oncological resection feasible in only 13% of patients [3,6,7]. "
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    ABSTRACT: Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.
    Cancers 12/2011; 3(1):636-51. DOI:10.3390/cancers3010636
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    • "Tumor size and lymph node involvement are well-known prognostic indicators for pancreatic cancer and, along with distant metastases, form the trifecta of the current TNM-based AJCC staging for pancreatic cancer. Many studies have shown that patients with a tumor larger than 2 cm or lymph node involvement have a significantly lower median and 5-year survival.6–11,17–21 Other studies show that patients who are elderly have a worse outcome than younger patients after surgical resection of pancreatic cancer.22,23 "
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    Annals of Surgical Oncology 09/2010; 17(9):2312-20. DOI:10.1245/s10434-010-1071-7 · 3.93 Impact Factor
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    • "However, stepwise variable selection was not performed, and the definition of the retroperitoneal margin was restricted to the area directly adjacent to the superior mesenteric artery. Evaluating individual resection margins in 160 resected pancreatic adenocarcinomas, Kuhlmann et al. [5] found that R0 resection independently predicted a favourable prognosis, but did not report the independent prognostic importance for survival of the retroperitoneal margin in particular. Thus, to establish whether or not involvement of the retroperitoneal resection margin independently predicts the prognosis also in ductal pancreatic adenocarcinoma, larger studies using standardized evaluation of both tumour origin and the individual resection margins should be performed. "
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    ABSTRACT: The retroperitoneal margin is frequently microscopically tumour positive in non-curative periampullary adenocarcinoma resections. This margin should be evaluated by serial perpendicular sectioning. The aim of the study was to determine whether retroperitoneal margin involvement independently predicts survival after pancreaticoduodenectomy within a framework of standardized assessment of the resected specimens. 114 consecutive macroscopically margin-free periampullary adenocarcinomas were examined according to a prospective standardized protocol for histopathologic evaluation. The retroperitoneal margin was assessed by serial perpendicular sectioning. The periampullary cancer origin (pancreas, ampulla, distal bile duct or duodenum) was registered prospectively and reevaluated retrospectively. Associations between histopathologic factors were evaluated by Chi-square test, Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney test, as appropriate. Survival curves were calculated by the Kaplan-Meier method and compared using the log-rank test. Associations between histopathologic factors and survival were also evaluated by unadjusted and adjusted Cox regression analysis, including stepwise variable selection, in order to identify factors that independently predict a poor prognosis after periampullary adenocarcinoma resections. Microscopic resection margin involvement (R1 resection) was present in 40 tumours, of which 32 involved the retroperitoneal margin. Involvement of the retroperitoneal margin independently predicted a poor prognosis (p = 0.010; HR 1.89; CI 1.16-3.08) after presumed curative (R0 and R1) resection. In microscopically curative (R0) resections (n = 74), pancreatic tumour origin was the only factor that independently predicted a poor prognosis (p < 0.001; HR 4.71 for pancreatic versus ampullary; CI 2.13-10.4). Serial perpendicular sectioning of the retroperitoneal resection margin demonstrates that tumour involvement of this margin independently predicts survival after pancreaticoduodenectomy for adenocarcinoma. Periampullary tumour origin is the only histopathologic factor that independently predicts survival in microscopically curative (R0) resections.
    BMC Cancer 01/2008; 8(1):5. DOI:10.1186/1471-2407-8-5 · 3.36 Impact Factor
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