Objective: To determine which clinicopathological features (CPF) influence survival in patients with resected pancreatic cancer (PC).
Methods: From June 1990 to November 2005, 396 patients underwent pancreaticoduodenectomy (PD) for periampullary tumors. Of these 144 patients had PD for PC and were analyzed for CPF influencing survival.
Results: Of the 144 patients reviewed, there were 83 males and 61 females with a median age of 68 years. PD with pancreaticojejunostomy (PJ) was performed in 58 patients and pancreaticogastrostomy (PG) in 86 patients. Median operative time was 6.5 hours and median blood loss was 950cc. The mortality rate and morbidity rate was 0.7% (n=1) and 23% (n=33) and 3 patients (2%) required reoperation. Clinical factors having a negative influence on survival included jaundice (P=0.009), abdominal/back pain (P=0.02), albumin <3 g/dL (P=0.01), cardiac complications (P=0.002), and pancreatic fistula (P=0.01). Pathological factors having a negative impact on survival were tumor differentiation (P=0.01), direct extension of tumor into neighboring organs (P=0.05), lymphovascular invasion (P=0.05), perineural invasion (P=0.05), positive lymph nodes (P=0.03), and a positive posterior pancreatic margin (P=0.007). Factors that had no influence on survival included the stage (P=0.11), tumor size <3cm (P=0.31), and adjuvant therapy (P=.13). The disease specific survival of the entire cohort was 64%, 30%, and 17% at 1, 3, and 5 years, with a median survival of 17 months. Patients who had PG had improved survival over those who had PJ (P=0.03).
Conclusion: 1) Clinical factors affecting survival were jaundice, abdominal/back pain, albumin <3 g/dL, cardiac complications, and pancreatic fistula. 2) Pathological factors influencing survival were tumor differentiation, invasion of neighboring organs, lymphovascular invasion, perineural invasion, positive lymph nodes, and positive posterior pancreatic margin. 3) Patients who had PG when compared to PJ had improved survival. 4) PD remains the treatment of choice for patients with resectable PC with disease specific survival of 64%, 30%, and 17% at 1, 3, and 5 years, respectively.