Back to 2011 Program

Survival after surgery for pancreatic cancer (PaCa) remains poor, even after curative resection. Factors like nodal disease (lymph node ratio), resection margin, grading and tumor size have been identified as prognostic factors in many series. Overweight/adipositas has recently been suggested as a further (negative) prognostic factor. Perioperative complications and blood transfusions (blood-Tx) have been suggested to worsen prognosis in various cancers. We analyzed our current experience after resection of PaCa with additional consideration of the above mentioned parameters.Methods: Long term outcome could be assessed in 270 patients after resection of PaCa (81% head, 13% distal, 6% total pancreatectomy) since 1995. Perioperative blood transfusions were given in 46%. One third of the patients underwent additional mesenterico-portal vein resection. Free margins were achieved in 71%. 70% had nodal disease, and 45% had more than one positive node. Postoperative morbidity was 49% (any), 31% (surgical) or 10% (severe; requiring relaparotomy and/or mechanical ventilation), respectively. Survival was analyzed by a Kaplan-Meier-method and the Cox-regression model. Results: Overall five year survival was 16% (16 true five year survivors). In univariate analysis positive margins (p=0.002), more than one involved node (p<0.001), poor grading (G3/G4; p<0.02) and blood-Tx (p=0.004) were associated with poorer survival. Other parameters like BMI, tumor size, postoperative complications (all above definitions), vein resection, gender, location of PaCa/resection (head/distal) or time period of surgery did not influence survival. In multivariate (Cox) survival analysis, again, the resection margin (p<0.01; RR 1.5), metastatic nodes (> one; p=0.002; RR 1.6), blood-Tx (p=0.03, RR 1.3) and (borderline) grading (p=0.09) independently influenced prognosis.Conclusions: In our study long term prognosis after resection of pancreatic cancer was influenced not only by ‘established’ tumor-related parameters but also by perioperative blood transfusions. This effect seems to be independent of perioperative complications or type/extent of resection. In contrast to other recently published results we could not demonstrate an impact of body mass index on prognosis.