Elsevier

Surgery

Volume 152, Issue 3, Supplement, September 2012, Pages S43-S49
Surgery

Pancreatic ductal adenocarcinoma: Long-term survival does not equal cure

https://doi.org/10.1016/j.surg.2012.05.020Get rights and content

Background

Pancreatic ductal adenocarcinoma represents 90% of pancreatic cancers and is an important cause of cancer death in the United States. Operative resection remains as the only treatment providing prolonged survival, but even after a curative resection, 5-year survival rates are low. Our aim was to identify the prognostic factors for long-term survival after resection of pancreatic ductal adenocarcinoma related to patients, treatments, and tumor biology.

Methods

Retrospective review identified 959 patients who underwent resection of their pancreatic adenocarcinoma between February 1985 and December 2010, of whom 499 were resected before November 2006 and represent the cohort we describe in this study. Patient, tumor, and treatment-related variables were assessed for their associations with 5- and 10-year overall survival.

Results

Of the 499 patients, 49% were female and median age was 65 years. The majority of patients had stage IIb disease (60%). Actual 5-year survival after resection of pancreatic adenocarcinoma was 19% (95/499), and actual 10-year survival was 10% (33/329). Significant clinicopathologic factors predicting 5- and 10-year survival were negative margins and negative nodal status. Interestingly, 41% (39/95) of long-term survivors had positive nodes and 24% (23/95) had positive margins.

Conclusion

Pancreatic ductal adenocarcinoma demonstrates a very heterogeneous biology, but patients with negative resection margins and node negative cancers are more likely to survive 5 years after resection. However, our series demonstrates that the biology of the cancer rather than simple pathologic factors determine a patient's prognosis.

Section snippets

Methods

We retrospectively reviewed a database of all patients who underwent pancreatic resection at the Massachusetts General Hospital between February 1985 and November 2006 and identified 499 patients who underwent resection for pathologically confirmed pancreatic ductal adenocarcinoma.

Patient-, tumor-, and treatment-related variables were evaluated. Patient factors evaluated included age, gender, smoking status, and family history. Treatment factors included the type of operation, adjuvant therapy,

Clinicopathologic factors

Between February 1985 and November 2006, 499 patients underwent complete gross resection of a pathologically confirmed pancreatic ductal adenocarcinoma. The cohort was approximately half female (49%) with a median age at diagnosis of 65 years (range, 31–91). The majority of patients (84%) underwent pancreaticoduodenectomy and had stage IIb disease (60%). One third of the patients 35% (174/499) received chemotherapy and 66% (329/499) received radiotherapy with chemotherapy. Even though receiving

Discussion

Most pancreatic cancers are diagnosed at an advance stage. This, together with the aggressiveness of the disease and the lack of effective systemic therapies, results in low rates of overall survival. Operative resection remains the only chance for long-term survival, despite advances in adjuvant and neoadjuvant therapies. The perioperative morbidity and mortality of pancreatic surgery has decreased to 24% and 2%, respectively, over the last 30 years.6, 7, 8 Despite all of these improvements,

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