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. 2009 Apr;16(4):836-47.
doi: 10.1245/s10434-008-0295-2. Epub 2009 Feb 5.

Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma

Matthew H G Katz  1 , Huamin Wang, Jason B Fleming, Charlotte C Sun, Rosa F Hwang, Robert A Wolff, Gauri Varadhachary, James L Abbruzzese, Christopher H Crane, Sunil Krishnan, Jean-Nicolas Vauthey, Eddie K Abdalla, Jeffrey E Lee, Peter W T Pisters, Douglas B Evans
Affiliations

Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma

Matthew H G Katz et al. Ann Surg Oncol. 2009 Apr.

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.

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Figures

FIG. 1
FIG. 1
(a) Actual overall and (b) disease-specific survival of patients with resectable or borderline resectable pancreatic adenocarcinoma who were evaluated at M. D. Anderson Cancer Center between 1990 and 2002 and who underwent resection
FIG. 2
FIG. 2
Frequency, location, and timing of disease recurrence after resection for patients with resectable and borderline resectable pancreatic adenocarcinoma
See this image and copyright information in PMC

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