Detrimental effect of postoperative complications on oncologic efficacy of R0 pancreatectomy in ductal adenocarcinoma of the pancreas

Abstract

Background: Margin-negative resection of pancreatic cancers has proven to be the most effective treatment to date. Although there are frequent surgery-related complications following pancreatectomy, the oncologic effect of these complications following pancreatectomy for pancreatic cancer has not been studied.

Materials and methods: Retrospective observation of medical records of resected pancreatic ductal adenocarcinoma performed from January 1990 to June 2006 was used in this study. Potentially curative surgical resections of pancreatic ductal adenocarcinoma were performed on 103 patients. Survival was analyzed according to various clinicopathologic variables.

Results: Negative surgical margins (p = 0.0075) and absence of postoperative major complications related to surgery (p = 0.0116) were all significantly favorable prognostic factors in both univariate and multivariate analysis. Margin-negative pancreatectomy without major complications showed the most favorable oncologic outcomes in resected pancreatic cancer (median survival, 35.6 months; 95% confidential interval, 25.8-45.4 months), while major morbidities diminished survival benefit of R0 resection [R0-Cx(+), Exp(beta) = 1.925, p = 0.034, and R1, Exp(beta) = 3.129, p = 0.001].

Conclusion: Surgery-related major complication diminished the oncologic efficacy of R0 pancreatectomy. Margin-negative resection without major complication can enhance postoperative oncologic outcomes in ductal adenocarcinoma of the pancreas.