Despite advances in surgical and oncological treatment the prognosis of patients with pancreatic cancer (PaCa) remains poor, even after so-called curative resection. We analyzed our results of surgery for PaCa and especially evaluated the influences of resection margins and non-resectional (palliative) operations on survival.
Methods: From 1994 to 2005 196 patients underwent surgery for pancreatic head cancer (144 pancreatoduodenectomy (PD), 52 single or double bypass for unresectable or metastasized cancer). For further analysis patients were classified as resected with negative margins (R-0; n=104), with microscopically involved margins (R-1; n=33), macroscopic tumor remnants (R-2; n=7) or palliative operations (bypass; n=52). Long-term survival was evaluated by the Kaplan-Meier and Cox-regression-methods. All operative specimens of patients surviving more than five years were re-evaluated by a pathologist experienced in pancreatic cancer.
Results: Mortality was 4% in both the PD-group and the bypass-group. Surgical complications occurred in 27% (PD) and 14% (bypass; p=0.07). Postoperative length of stay was between 13 and 17 days in the different groups. In the 40 patients with positive margins tumor cells were present at the retroperitoneal margin (22), SMA (5), pancreatic transsection site (6), portal vein resection margin (5) or others (2). Median survival was 22 months (R-0), 18 months (R-1), 9 months (R-2) and 7 months (bypass; p<0.02). The difference in survival between the R-0- and the R-1-group was only marginally (p=0.06). In multivariate analysis, however, the status of the resection margin and the tumor grading were the two independent factors influencing survival (p<0.05). Eight patients, two even with positive margins and subsequent chemotherapy, survived more than five years after PD. Ductal PaCa was histologically re-confirmed in all of them. The longest survival was 9.8 years (patient still alive).
Conclusions: The status of the resection margins significantly influences the prognosis in patients with cancer of the pancreatic head. Performing a PD as a ‘palliative’ R-1-resection, in contrast to a R-2-resection, also may achieve a relevant gain of survival.