Introduction: Pancreatic ductal adenocarcinoma is uncommon in patients less than 50 years of age and the surgical management has not been described in large series. Our aim was to describe the presentation, management, and outcome of patients < 50 years of age who underwent surgical treatment.
Methods: We retrospectively reviewed all patients less than 50 years of age who underwent operative management of pancreatic ductal adenocarcinoma between the years 1988 and 2005.
Results: A total of 66 patients, mean age 43 years (range: 29 - 49) were identified. Followup was complete in 94% for a mean of 36 months. Presenting symptoms included weight loss (59%), abdominal pain (58%), and jaundice (55%). A history of other cancer was present in 17% of patients. Whereas 50% of patients had a family history of cancer, in only 6% was this pancreatic. R0 resection was achieved in 49 (74%) patients, requiring pancreaticoduodenectomy (n=50), distal pancreatectomy (n=12), or total pancreatectomy (n=4). Mean tumor size was 4 cm with lymph node metastases present in 50%. In hospital or 30-day mortality occurred in 1 patient (1.5%). Serious morbidity occurred in 20 patients (30%) with need for perioperative blood transfusion (17%) and pancreatic fistula (9%) being the most common. Median length of hospital stay was 11 days (range: 6-78). Fifty-two patients (79%) received adjuvant chemotherapy and/or radiation treatment. Tumor recurrence occurred in 84% after a mean of 13 months. Actual 5-year survival in this series is 18% (12/66).
Conclusions: Pancreatic adenocarcinoma in patients less than 50 years of age is uncommon representing < 10% of all patients undergoing operative management. Clinical presentation and outcomes are similar to that reported for older patients. Surgical resection remains the primary treatment for resectable pancreatic adenocarcinoma providing opportunity for prolonged survival. Further investigations regarding potential genetic or molecular differences in this young age group may provide unique detection and treatment options.