Abstract
Background
Some patients operated by pancreaticoduodenectomy for resectable pancreatic head adenocarcinoma will present with a recurrence during the first year (early recurrence).
Objective
The aim of this study was to determine prognostic factors associated with early recurrence in a large retrospective study.
Methods
From January 1995 to November 2010, all patients operated by pancreaticoduodenectomy for pancreatic head adenocarcinoma in our institution were retrospectively included. Univariate and multivariate analyses were performed to determine factors associated with early recurrence.
Results
A total of 166 patients were included; 57 patients (34 %) developed early recurrence. In univariate analysis, factors associated with early recurrence were perineural invasion (p = 0.0002), preoperative bilirubin (p = 0.01), lymph node ratio (LNR) ≥0.2 (p = 0.009), and T stage (p = 0.02). In multivariate analysis, perineural invasion (odds ratio [OR] 3.31; 95 % confidence interval [CI] 1.42–7.72; p = 0.005), LNR ≥0.2 (OR 2.55; 95 % CI 1.17–5.52; p = 0.02), and preoperative bilirubin (OR 1.04; 95 % CI 1.01–1.07; p = 0.03) were independent factors associated with early recurrence. Perineural invasion was also associated with poor overall survival (p = 0.001) and poor disease-free survival (p = 0.07).
Conclusion
In our study, perineural invasion (OR 3.31) is more accurate than T stage and lymph node status (OR 2.55) to predict early recurrence after pancreatoduodenectomy for pancreatic head adenocarcinoma.
Similar content being viewed by others
References
Trede M, Schawall G, Saeger HD (1990) Survival after pancreaticoduodenectomy. 118 Consecutive resections without an operative mortality. Ann Surg 211:447–458
Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications and outcomes. Ann Surg 226:248–257
Nitecki SS, Sarr MG, Colby TV et al (1995) Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg 221:59–66
Moreaux J, Catala M, Marzano L (1984) Results of the surgical treatment of pancreatic cancer. Study of a series of 96 surgically treated patients. Gastroenterol Clin Biol 8:11–16
Magistrelli P, Antinori A, Crucitti A et al (2000) Prognostic factors after surgical resection for pancreatic carcinoma. J Surg Oncol 74:36–40
Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297:267–277
Neoptolemos JP, Moore MJ, Cox TF et al (2012) Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308:147–156
Kim EJ, Ben-Jospef E, Herman JM et al (2013) A multi-institutional phase 2 study of neo adjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer. Cancer 119:2692–2700
Zhang Y, Adam EF, Kyriakides C et al (2012) Loco-recurrence after resection for ductal adenocarcinoma of the pancreas: predictors and implications for adjuvant chemotherapy. J Cancer Res Clin Oncol 138:1063–1071
Slidell MB, Chang DC, Cameron JL et al (2008) Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 15:165–174
Verbeke CS, Menon KV (2009) Redefining resection margin status in pancreatic cancer. HPB (Oxf) 11:282–289
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and result of Survey. Ann Surg 240:205–213
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768
Hartwig W, Hackert T, Hinz U et al (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254:311–319
Helm J, Centeno BA, Coppola D et al (2009) Histologic characteristics enhance predictive value of American Joint Committee on Cancer staging in resectable pancreas cancer. Cancer 115:4080–4089
Jentzer A (1930) Neurotropisme des cellules cancéreuses: clinique et thérapeutique des cancers neurotropes. Schweiz Med Wochenschr 60:1050–1052
Obyama K (1984) Clinicopathologic study on resected cases of carcinoma of the pancreas: prognosis and lymphatic metastasis. Jpn J Surg 85:820–834
Chen JW, Bhandari M, Astill DS et al (2010) Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB (Oxf) 12:101–108
Shimada K, Nara S, Esaki M et al (2011) Intrapancreatic nerve invasion as a predictor for recurrence after pancreaticoduodenectomy in patients with invasive ductal carcinoma of the pancreas. Pancreas 40:464–468
Neoptolemos JP, Stocken DD, Bassi C et al (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081
Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825
Riediger H, Keck T, Wellner U et al (2009) The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg 13:1337–1344
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fouquet, T., Germain, A., Brunaud, L. et al. Is Perineural Invasion More Accurate Than Other Factors to Predict Early Recurrence after Pancreatoduodenectomy for Pancreatic Head Adenocarcinoma?. World J Surg 38, 2132–2137 (2014). https://doi.org/10.1007/s00268-014-2465-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2465-7