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

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

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319 Scopus citations

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 1 2008

ASJC Scopus subject areas

  • Surgery

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    Schnelldorfer, T., Ware, A. L., Sarr, M. G., Smyrk, T. C., Zhang, L., Qin, R., Gullerud, R. E., Donohue, J. H., Nagorney, D. M., & 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