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Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma.

Abstract：

INTRODUCTION:Actual 5-year survival rates of 10-18% have been reported for patients with resected pancreatic adenocarcinoma (PC), but the use of multimodality therapy was uncommon in these series. We evaluated long-term survival and patterns of recurrence in patients treated for PC with contemporary staging and multimodality therapy. METHODS:We analyzed 329 consecutive patients with PC evaluated between 1990 and 2002 who underwent resection. Each received a multidisciplinary evaluation and a standard operative approach. Pre- or postoperative chemotherapy and/or chemoradiation were routine. Surgical specimens of 5-year survivors were re-reviewed. A multivariate model of factors associated with long-term survival was constructed. RESULTS:Patients underwent pancreaticoduodenectomy (n = 302; 92%), distal (n = 20; 6%), or total pancreatectomy (n = 7; 2%). A total of 108 patients (33%) underwent vascular reconstruction, 301 patients (91%) received neoadjuvant or adjuvant therapy, 157 specimens (48%) were node positive, and margins were microscopically positive in 52 patients (16%). Median overall survival and disease-specific survival was 23.9 and 26.5 months. Eighty-eight patients (27%) survived a minimum of 5 years and had a median overall survival of 11 years. Of these, 21 (24%) experienced recurrence, 7 (8%) after 5 years. Late recurrences occurred most frequently in the lungs, the latest at 6.7 years. Multivariate analysis identified disease-negative lymph nodes (P = .02) and no prior attempt at resection (P = 0.01) as associated with 5-year survival. CONCLUSIONS:Our 27% actual 5-year survival rate for patients with resected PC is superior to that previously reported, and it is influenced by our emphasis on detailed staging and patient selection, a standardized operative approach, and routine use of multimodality therapy.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Katz MH,Wang H,Fleming JB,Sun CC,Hwang RF,Wolff RA,Varadhachary G,Abbruzzese JL,Crane CH,Krishnan S,Vauthey JN,Abdalla EK,Lee JE,Pisters PW,Evans DB

doi

10.1245/s10434-008-0295-2

subject

Has Abstract

pub_date

2009-04-01 00:00:00

pages

836-47

issue

eissn

1068-9265

issn

1534-4681

journal_volume

pub_type

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Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma.