Analysis of 5-Year Survivors After a Macroscopic Curative Pancreatectomy for Invasive Ductal Adenocarcinoma
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- Shimada, K., Sakamoto, Y., Nara, S. et al. World J Surg (2010) 34: 1908. doi:10.1007/s00268-010-0570-9
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Surgical resections for invasive ductal adenocarcinoma of the pancreas can provide the only chance of cure, although the 5-year survivors are not always equated with cure.
A total of 229 who underwent a macroscopic curative pancreatectomy for invasive ductal adenocarcinoma between 1990 and 2003 and have been observed for more than 5 years from the time of resection were retrospectively analyzed. The data of patients who survived more than 5 years were compared with those died within 5 years. The recurrence pattern and factors that influenced an additional 5-year survival in the 5-year survivors were investigated.
Forty patients (17%) survived more than 5 years, and the survival rate for an additional 5 years after surviving 5 years was 72%. A multivariate Cox hazards analysis showed that negative surgical margins status, less frequency of lymphatic invasion, stage ≤ IIB, and negative lymph node involvement were independent factors associated with long-term survival. Thirty patients (75%) were alive without recurrence, and eight (20%) died of disease within 7.3 years. Intrapancreatic nerve invasion was a significant factor predicting additional long-term survival in the 40 5-year survivors.
Limited cancer extension with negative lymph node metastases significantly contributes to the chance of surviving more than 5 years. A low incidence of intrapancreatic nerve invasion in the 5-year survivors affects the subsequent favorable survival.