Survival and quality of life following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

doi:10.33140/ijcrt.06.02.07

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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The Results of Pancreatic Resections and Long-Term Survival for Pancreatic Ductal Adenocarcinoma: A Single-Institution Experience

Scandinavian Journal of Surgery ◽

10.1177/1457496916645963 ◽

2016 ◽

Vol 106 (1) ◽

pp. 54-61 ◽

Cited By ~ 15

Author(s):

H. Seppänen ◽

A. Juuti ◽

H. Mustonen ◽

C. Haapamäki ◽

S. Nordling ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Pancreatic Surgery ◽

Survival Rates ◽

Mortality Rates ◽

Ductal Adenocarcinoma ◽

Term Survival ◽

Long Term Survival ◽

Pancreatic Resections ◽

Operation Rate

Objectives: Since the early 1990s, low long-term survival rates following pancreatic surgery for pancreatic ductal adenocarcinoma have challenged us to improve treatment. In this series, we aim to show improved survival from pancreatic ductal adenocarcinoma during the era of centralized pancreatic surgery. Methods: Analysis of all pancreatic resections performed at Helsinki University Hospital and survival of pancreatic ductal adenocarcinoma patients during 2000–2013 were included. Post-operative complications such as fistulas, reoperations, and mortality rates were recorded. Patient and tumor characteristics were compared with survival data. Results: Of the 853 patients undergoing pancreatic surgery, 581 (68%) were pancreaticoduodenectomies, 195 (21%) distal resections, 28 (3%) total pancreatectomies, and 49 (6%) other procedures. Mortality after pancreaticoduodenectomy was 2.1%. The clinically relevant B/C fistula rate was 7% after pancreaticoduodenectomy and 13% after distal resection, and the re-operation rate was 5%. The 5- and 10-year survival rates for pancreatic ductal adenocarcinoma were 22% and 14%; for T1-2, N0 and R0 tumors, the corresponding survival rates were 49% and 31%. Carbohydrate antigen 19-9 >75 kU/L, carcinoembryonic antigen >5 µg/L, N1, lymph-node ratio >20%, R1, and lack of adjuvant therapy were independent risk factors for decreased survival. Conclusion: After centralization of pancreatic surgery in southern Finland, we have managed to enable pancreatic ductal adenocarcinoma patients to survive markedly longer than in the early 1990s. Based on a 1.7-million population in our clinic, mortality rates are equal to those of other high-volume centers and long-term survival rates for pancreatic ductal adenocarcinoma have now risen to some of the highest reported.

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Long-Term Survival and Quality of Life After Transfusion-Associated Pulmonary Edema in Critically III Medical Patients

CHEST Journal ◽

10.1378/chest.09-0841 ◽

2010 ◽

Vol 137 (4) ◽

pp. 783-789 ◽

Cited By ~ 40

Author(s):

Guangxi Li ◽

Marija Kojicic ◽

Martin K. Reriani ◽

Evans R. Fernández Pérez ◽

Lokendra Thakur ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Edema ◽

Medical Patients ◽

Term Survival ◽

Long Term Survival

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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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