World Journal of Surgery

, Volume 34, Issue 8, pp 1908–1915

Analysis of 5-Year Survivors After a Macroscopic Curative Pancreatectomy for Invasive Ductal Adenocarcinoma

  • Kazuaki Shimada
  • Yoshihiro Sakamoto
  • Satoshi Nara
  • Minoru Esaki
  • Tomoo Kosuge
  • Nobuyoshi Hiraoka
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

References

  1. 1.
    Conlon KC, Klimstra DS, Brennan MF (1996) Long-term survival after curative resection for pancreatic ductal adenocarcinoma: clinicopathologic analysis of 5-year survivors. Ann Surg 223:273–279Google Scholar
  2. 2.
    Matsuno S, Egawa S, Fukuyama S et al (2004) Pancreatic Cancer Registry in Japan: 20 years of experience. Pancreas 28:219–230CrossRefPubMedGoogle Scholar
  3. 3.
    Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas 616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579CrossRefPubMedGoogle Scholar
  4. 4.
    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 control trial. JAMA 297:267–277CrossRefPubMedGoogle Scholar
  5. 5.
    Cleary SP, Gryfe R, Guindi W et al (2004) Prognostic factors in resected pancreatic adenocarcinoma: analysis of 5-year survivors. J Am Coll Surg 198:722–731CrossRefPubMedGoogle Scholar
  6. 6.
    Riall TS, Cameron JL, Lillemoe KD et al (2006) Resected periampullary adenocarcinoma: 5-year survivors and their 6- to-10-year follow-up. Surgery 140:764–772CrossRefPubMedGoogle Scholar
  7. 7.
    Han SS, Jang JY, Kim SW, Kim WH, Lee KU, Park YH (2006) Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas 32:271–275CrossRefPubMedGoogle Scholar
  8. 8.
    Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma. Is cure possible? Ann Surg 247:456–462CrossRefPubMedGoogle Scholar
  9. 9.
    Adham M, Jaeeck D, Borgne JL et al (2008) Long-term survival (5–20 years) after pancreatectomy for pancreatic ductal adenocarcinoma. A series of 30 patients collected from 3 institutions. Pancreas 37:352–357CrossRefPubMedGoogle Scholar
  10. 10.
    Ferrone CR, Brennan MF, Gonen M et al (2008) Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg 12:701–706CrossRefPubMedGoogle Scholar
  11. 11.
    Katz MHG, Wang H, Fleming JB et al (2009) Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol 16:836–847CrossRefPubMedGoogle Scholar
  12. 12.
    Japan Pancreas Society (2003) Classification of pancreatic carcinoma, 2nd English edn. Kanehara, TokyoGoogle Scholar
  13. 13.
    Sobin LH, Wittekind Ch (eds) (2002) International Union against Cancer. TNM classification of malignant tumors, 6th edn. Wiley, New YorkGoogle Scholar
  14. 14.
    Shimada K, Kosuge T, Yamamoto Y, Yamasaki S, Sakamoto M (2004) Successful outcome after resection of pancreatic cancer with a solitary hepatic metastasis. Hepatogastroenterology 51:603–605PubMedGoogle Scholar
  15. 15.
    Ishikawa O, Ohhigashi H, Sasaki Y et al (1988) Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 208:215–220CrossRefPubMedGoogle Scholar
  16. 16.
    Lϋttges J, Vogel I, Menke M, Henne-Bruns D, Kremer B, Klöppel G (1998) The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Virchows Arch 433:237–242CrossRefGoogle Scholar
  17. 17.
    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 115:4080–4089CrossRefPubMedGoogle Scholar
  18. 18.
    Ozaki H, Hiraoka T, Mizumoto R et al (1999) The prognostic significance of lymph node metastases and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today 29:16–22CrossRefPubMedGoogle Scholar
  19. 19.
    Ceyhan GO, Bergmann F, Kadihasanoglu M et al (2009) Pancreatic neuropathy and neuropathic pain: a comprehensive pathomorphological study of 546 cases. Gastroenterology 136:177–186CrossRefPubMedGoogle Scholar
  20. 20.
    Magnin V, Viret F, Moutardier V et al (2004) Complete pathologic responses to preoperative chemoradiation in two patients with adenocarcinoma of the pancreas. Pancreas 28:103–104CrossRefPubMedGoogle Scholar
  21. 21.
    Le Scodan R, Mornex F, Partensky C et al (2008) Histopathological response to preoperative chemoradiation for resectable pancreatic adenocarcinoma: the French Phase II FFCD 9704-SFRO Trial. Am J Clin Oncol 31:545–552CrossRefPubMedGoogle Scholar
  22. 22.
    Egawa S, Takeda K, Fukuyama S, Motoi F, Sunamura M, Matsuno S (2004) Clinicopathological aspect of small pancreatic cancer. Pancreas 28:235–240CrossRefPubMedGoogle Scholar
  23. 23.
    Gleisner AL, Assumpcao L, Cameron JL et al (2007) Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 110:2484–2492CrossRefPubMedGoogle Scholar
  24. 24.
    Stitzenberg KB, Watson JC, Roberts A et al (2008) Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol 15:1399–1406CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Kazuaki Shimada
    • 1
  • Yoshihiro Sakamoto
    • 1
  • Satoshi Nara
    • 1
  • Minoru Esaki
    • 1
  • Tomoo Kosuge
    • 1
  • Nobuyoshi Hiraoka
    • 2
  1. 1.Hepatobiliary and Pancreatic Surgery DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Pathology DivisionNational Cancer Center Research InstituteTokyoJapan

Personalised recommendations