2005 Abstracts: Improved Survival for Adenocarcinoma of the Pancreas After Pancreaticoduodenectomy
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Improved Survival for Adenocarcinoma of the Pancreas After Pancreaticoduodenectomy
Kevork K. Kazanjian, Oscar J. Hines, John P. Duffy, Guido Eibl, Diana Y. Yoon, Galen Cortina, Howard A. Reber, David Geffen School of Medicine at UCLA, Los Angeles, CA
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.
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