Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma is cure possible?

Thomas Schnelldorfer, Adam L. Ware, Michael G. Sarr, Thomas Christopher Smyrk, Lizhi Zhang, Rui Qin, Rachel E. Gullerud, John H. Donohue, David M. Nagorney, Michael B. Farnell

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Abstract

Objective: To determine long-term survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma and to identify clinical factors associated with long-term survival. Summary Background Data: 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. Methods: 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. Results: 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 (<5 years, n = 295) and long-term (=5 years, n = 62) survival showed that more advanced disease (greatest tumor diameter, lymph node metastasis) and decreased serum albumin concentration were unfavorable for longterm 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)456-462
Number of pages7
JournalAnnals of Surgery
Volume247
Issue number3
DOIs
StatePublished - Mar 2008

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Pancreaticoduodenectomy
Adenocarcinoma
Survival
Lymph Nodes
Pancreatic Neoplasms
Survivors
Case-Control Studies
Pancreas
Cohort Studies
Multivariate Analysis
Survival Rate
Observation

ASJC Scopus subject areas

  • Surgery

Cite this

Schnelldorfer, T., Ware, A. L., Sarr, M. G., Smyrk, T. C., Zhang, L., Qin, R., ... Farnell, M. B. (2008). Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma is cure possible? Annals of Surgery, 247(3), 456-462. https://doi.org/10.1097/SLA.0b013e3181613142

Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma is cure possible? / Schnelldorfer, Thomas; Ware, Adam L.; Sarr, Michael G.; Smyrk, Thomas Christopher; Zhang, Lizhi; Qin, Rui; Gullerud, Rachel E.; Donohue, John H.; Nagorney, David M.; Farnell, Michael B.

In: Annals of Surgery, Vol. 247, No. 3, 03.2008, p. 456-462.

Research output: Contribution to journalArticle

Schnelldorfer, T, Ware, AL, Sarr, MG, Smyrk, TC, Zhang, L, Qin, R, Gullerud, RE, Donohue, JH, Nagorney, DM & Farnell, MB 2008, 'Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma is cure possible?', Annals of Surgery, vol. 247, no. 3, pp. 456-462. https://doi.org/10.1097/SLA.0b013e3181613142
Schnelldorfer, Thomas ; Ware, Adam L. ; Sarr, Michael G. ; Smyrk, Thomas Christopher ; Zhang, Lizhi ; Qin, Rui ; Gullerud, Rachel E. ; Donohue, John H. ; Nagorney, David M. ; Farnell, Michael B. / Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma is cure possible?. In: Annals of Surgery. 2008 ; Vol. 247, No. 3. pp. 456-462.
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abstract = "Objective: To determine long-term survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma and to identify clinical factors associated with long-term survival. Summary Background Data: 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. Methods: 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. Results: 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 (<5 years, n = 295) and long-term (=5 years, n = 62) survival showed that more advanced disease (greatest tumor diameter, lymph node metastasis) and decreased serum albumin concentration were unfavorable for longterm 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. Conclusion: 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.",
author = "Thomas Schnelldorfer and Ware, {Adam L.} and Sarr, {Michael G.} and Smyrk, {Thomas Christopher} and Lizhi Zhang and Rui Qin and Gullerud, {Rachel E.} and Donohue, {John H.} and Nagorney, {David M.} and Farnell, {Michael B.}",
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AU - Schnelldorfer, Thomas

AU - Ware, Adam L.

AU - Sarr, Michael G.

AU - Smyrk, Thomas Christopher

AU - Zhang, Lizhi

AU - Qin, Rui

AU - Gullerud, Rachel E.

AU - Donohue, John H.

AU - Nagorney, David M.

AU - Farnell, Michael B.

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N2 - Objective: To determine long-term survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma and to identify clinical factors associated with long-term survival. Summary Background Data: 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. Methods: 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. Results: 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 (<5 years, n = 295) and long-term (=5 years, n = 62) survival showed that more advanced disease (greatest tumor diameter, lymph node metastasis) and decreased serum albumin concentration were unfavorable for longterm 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. Conclusion: 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.

AB - Objective: To determine long-term survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma and to identify clinical factors associated with long-term survival. Summary Background Data: 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. Methods: 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. Results: 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 (<5 years, n = 295) and long-term (=5 years, n = 62) survival showed that more advanced disease (greatest tumor diameter, lymph node metastasis) and decreased serum albumin concentration were unfavorable for longterm 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. Conclusion: 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.

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