Introduction: In the USA, reported survival rates after pancreaticoduodenectomy (PD) for ductal adenocarcinoma (PaCa) rarely exceed 20%. We reviewed our own experience with PD for PaCa and the factors influencing survival.
Methods: A retrospective analysis of a prospectively collected database of 465 consecutive PD's from 1987-2004 was performed. One hundred seventy-five PD's were done for PaCa; the 158 patients who had at least 1 year follow-up were analyzed. Patients with other periampullary Ca's, and PaCa's arising from cystic neoplasms or IPMNs were excluded. Follow-up was through medical records, telephone contact, and the Social Security Administration. Actuarial survival (Kaplan-Meier) was determined and comparisons made using the log-rank test. Multivariate analysis was performed using a Cox proportional hazards model. Significance requiredp < 0.05. A separate analysis was done for two time periods: 1987-1995 (n = 56) and 1996-2003 (n = 102). Results: Median age of the entire cohort was 66 years (58% male; 90% Caucasian). There were no perioperative deaths; postoperative morbidity rate was 42%; median EBL was 400 ml. Perineural invasion was present in 60% of tumors, 50% had +lymph nodes (LN), 24% had lymphovascular invasion, 15% had +resection margins, and 36% were poorly differentiated. The overall 5-year actuarial survival rate was 25% (median follow-up 21 months). The 5-year actual survival rate was 20.4%. For the 1987-1995 cohort, 5-year actuarial survival was 16%; for the 1996-2003 group, actuarial survival was 33% (p = 0.03). Unfavorable independent prognostic factors on multivariate analysis included perineural invasion (p < 0.002), EBL > 500 ml (p = 0.001), poor tumor differentiation (p = 0.001), and +LN (p = 0.02). PD after 1995 was a favorable independent prognostic factor (p < 0.02). The more recent cohort had a demographic and pathologic profile comparable to the 1987-1995 cohort, but had a lower median operative EBL (350 vs 450 ml; p < 0.02). Nine different surgeons performed the PD's in the earlier cohort; one surgeon performed 90% of the resections in the later period. Conclusions: Since 1996, patients with resected PaCa have had an improved postoperative survival (33% at 5 years), to a degree previously unreported. The reasons for this improved outcome are likely to be multifactorial. Factors associated with poor survival included perineural invasion, poorly differentiated tumor, +LN, and high operative blood loss.
500 Cummings Center
+1 978-927-8330
+1 978-524-0498
