Three-year and five-year outcomes of surgical resection for pancreatic ductal adenocarcinoma: Long-term experiences in one medical center

243 Background: The number of incidentally discovered asymptomatic pancreatic ductal adenocarcinoma (APDAC) has been increasing along with recent wide spread use of imaging studies in general practice. However, the clinical implication in early detection of asymptomatic pancreatic cancer remains yet to be determined. In this study, we reviewed our experience of patients with PDAC in high volume cancer center and compared the characteristics and long-term outcomes between those with APDAC and symptomatic PDAC (SPDAC). Methods: This retrospective study included 569 consecutive patients with PDAC initially treated in our institution from January 2007 to December 2012. Median follow-up period was 29 months for the survivors. Two hundred and fifty patients underwent surgical resection and 319 patients were deemed unresectable. The patient’s demographics, tumor locations, pathologic stages, and treatment type received, and the overall survival (OS) were compared between the patients with APDAC and those with SPDAC. Results: One hundred and sixty-three patients (29%) presented without any subjective symptoms. When compared with SPDAC, APDAC was associated with early stage (stage I, 6% vs. 1%, p<0.01). Among 163 patients with APDAC, 104 patients (64%) underwent surgical resection, while only 146 patients (36%) out of 406 SPDAC underwent resection ( p<0.01). The 5-year OS rate of the patients with APDAC was 18%, comparing with 7% for those with SPDAC ( p<0.01). Among the patients who underwent resection, the presence of symptoms did not affect the chance of incomplete resection (R1, 12% vs. 22% for patients with APDAC and SPDAC, respectively, p=0.06) and the 5-year OS rate (23% vs. 22%, p=0.09). However, the patients with SPDAC required complex operation (concomitant vascular resection and reconstruction 56% vs. 29% for those with APDAC, p<0.01). Conclusions: Asymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC due to early stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening program for early detection of PDAC for selected high-risk patient population.

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Can Statistically Determined Prognostic Factors Predict the Long-Term Survival of Patients With Pancreatic Ductal Adenocarcinoma Following Surgical Resection?

Pancreas ◽

10.1097/mpa.0000000000000063 ◽

2014 ◽

Vol 43 (4) ◽

pp. 571-577 ◽

Cited By ~ 14

Author(s):

Sang Hyun Shin ◽

Song Cheol Kim ◽

Seung-Mo Hong ◽

Ki-Byung Song ◽

Jae Hoon Lee ◽

...

Keyword(s):

Prognostic Factors ◽

Pancreatic Ductal Adenocarcinoma ◽

Surgical Resection ◽

Ductal Adenocarcinoma ◽

Term Survival ◽

Long Term Survival

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Actual long-term outcome of T1 and T2 pancreatic ductal adenocarcinoma after surgical resection

International Journal of Surgery ◽

10.1016/j.ijsu.2017.02.007 ◽

2017 ◽

Vol 40 ◽

pp. 68-72 ◽

Cited By ~ 3

Author(s):

San Hyup Han ◽

Jin Seok Heo ◽

Seong Ho Choi ◽

Dong Wook Choi ◽

In Woong Han ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Surgical Resection ◽

Ductal Adenocarcinoma ◽

Term Outcome ◽

Long Term Outcome ◽

T1 And T2

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Intra-pancreatic distal cholangiocarcinoma and pancreatic ductal adenocarcinoma: a common short and long-term prognosis?

Updates in Surgery ◽

10.1007/s13304-021-00981-0 ◽

2021 ◽

Author(s):

Théophile Guilbaud ◽

Edouard Girard ◽

Coralie Lemoine ◽

Ghislain Schlienger ◽

Oyekashopefoluw Alao ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Ductal Adenocarcinoma ◽

Distal Cholangiocarcinoma ◽

Short And Long Term ◽

Long Term Prognosis

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Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02238-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Claudio F. Feo ◽

Giulia Deiana ◽

Chiara Ninniri ◽

Giuseppe Cherchi ◽

Paola Crivelli ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Locally Advanced ◽

Operating Time ◽

Vascular Resection ◽

Ductal Adenocarcinoma ◽

Term Survival ◽

Aggressive Approach ◽

Long Term Survival ◽

Cox Regression Analysis

Abstract Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis. Radical surgery is the best option for cure and, nowadays, it is performed by many surgeons also in cases of vascular infiltration. Whether this aggressive approach to a locally advanced PDAC produces a survival benefit is under debate. Most data in the literature come from retrospective comparative studies; therefore, it is still unclear if such an extensive surgery for an advanced cancer is justified. Methods A retrospective review of patients with PDAC treated at our institution over a 12-year period was performed. Data concerning patients’ characteristics, operative details, postoperative course, and long-term survival were retrieved from prospective databases and analysed. Factors associated with poor survival were assessed via Cox regression analysis. Results A total of 173 patients with PDAC were included in the analysis, 41 subjects underwent pancreatectomy with vascular resection for locally advanced disease, and in 132 patients, only a pancreatic resection was undertaken. Demographics, major comorbidities, and tumour characteristics were similar between the two groups. Length of surgery (P=0.0006), intraoperative blood transfusions (P<0.0001), and overall complications (P<0.0001) were significantly higher in the vascular resection group. Length of hospital stay (P=0.684) and 90-day mortality (P=0.575) were comparable between groups. Overall median survival (P= 0.717) and survival rates at 1, 3, and 5 years (P=0.964, P=0.500, and P=0.445, respectively) did not differ significantly between groups. Age ≥70 years and postoperative complications were independent predictors of lower survival. Conclusions Our study confirms that pancreatectomy with vascular resection for a locally advanced PDAC is a complex operation associated with a significant longer operating time that may increase morbidity; however, in selected patients, R0 margins can be obtained with an acceptable long-term survival rate. Older patients are less likely to benefit from surgery.

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Comparisons of Short-term and Long-term Outcomes Between Open and Laparoscopic Distal Pancreatectomy in Patients with Pancreatic Ductal Adenocarcinoma

HPB ◽

10.1016/j.hpb.2020.11.157 ◽

2021 ◽

Vol 23 ◽

pp. S65

Author(s):

J.M. Lee ◽

J.S. Kang ◽

Y. Byun ◽

Y.J. Choi ◽

Y. Han ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Distal Pancreatectomy ◽

Laparoscopic Distal Pancreatectomy ◽

Ductal Adenocarcinoma ◽

Long Term Outcomes ◽

Short Term

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Survival and quality of life following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

International Journal of Cancer Research & Therapy ◽

10.33140/ijcrt.06.02.07 ◽

2021 ◽

Vol 6 (2) ◽

Keyword(s):

Quality Of Life ◽

Pancreatic Ductal Adenocarcinoma ◽

Short Review ◽

Mortality Rates ◽

Ductal Adenocarcinoma ◽

Term Survival ◽

Long Term Survival ◽

Dismal Prognosis

Pancreatic ductal adenocarcinoma (PDAC) most commonly affects the head of the pancreas. This condition has a dismal prognosis. Patients with early disease may be candidates for pancreaticoduodenectomy (PD). This is a high-risk operation which is associated with considerable morbidity. Whilst perioperative mortality rates have fallen in recent times, the risk remains significant and long-term survival is poor, even in those who make an uncomplicated recovery. Furthermore, PD is known to affect quality of life (QoL) negatively. Most studies suggest it takes up to six months before a patient’s QoL returns to baseline. This is a considerable amount of time for a patient who is unlikely to achieve long-term survival. This short review discusses the recent literature surrounding mortality rates, long-term survival and QoL following PD for PDAC. A comprehensive understanding of these topics will allow clinicians and patients to consider the risks and benefits before surgical resection is considered.

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