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Objective: To determine clinicopathological features that influence survival in patients with resected pancreatic adenocarcinoma.
Methods: A retrospective review of a prospective database was conducted for patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma at a single institution from December 1993 to December 2010. Clinicopathologic features and cancer related outcomes were collected. The cohort was then analyzed for clinicopathological features influencing survival at 6 months, 1 year, 3 years, and 5 years.
Results: A total of 246 patients underwent pancreaticoduodenectomy for pancreatic adenocarcinoma. The cohort was comprised of 128 males (52%) and 118 females (48%), with a median age of 68 years. Median operative time was 6.25 hours with a median blood loss of 800cc. Median hospital length of stay was 8 days. A total of 7 patients (2.8%) required re-operation and 9% of patients were readmitted within 30 days for postoperative issues. The 30-day mortality rate was 2.4%(n=6).
There was a total of 101 associated complications in the postoperative period, with grade 3 or less accounting for 79% of the observed complications, based on the Dindo/Clavien complication scoring system. In regards to pancreaticoduodenectomy specific complications, 29 (11.8%) experienced delayed gastric emptying, 17 (6.9%) developed an anastomotic leak, with ISGPF grade A/B accounting for the majority of leaks observed (6%). Overall survival of the cohort was 85%, 63%, 25%, and 15% at 6 months, 1 year, 3 years, and 5 years respectively, with a median survival of 17 months.
Using multivariate logistic regression, clinical factors that influenced survival were abdominal pain and preoperative HTN, where the presence of pain preoperatively negatively correlated with survival at 3 years (p=0.021), and the presence of preoperative hypertension was negatively correlated with survival at 6 months, 3 years, and 5 years (p=0.012, p=0.013, p=0.019). Intraoperative estimated blood loss (EBL) showed a negative correlation with survival at 3 years (p=0.02), and the need for intraoperative blood transfusion was negatively correlated with survival at 3 years and 5 years (p=0.012 and p=0.019). The only pathologic factor to have a negative impact on survival was lymph node ratio (LNR), which correlated with decreased survival at 6 months, 1 year, and 3 years (p=0.033, p=0.035, p=0.01). Those who had no postoperative complications had higher odds of being alive at 6 months (p=0.002)
Conclusion: Clinical factors affecting survival were preoperative abdominal pain and hypertension. Intraoperative factors affecting survival were EBL and the need for blood transfusions. The only pathological factor affecting survival was LNR. Finally, an uncomplicated postoperative course was positively correlated with survival.