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1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience

  • 2005 SSAT Annual Meeting
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Pancreaticoduodenectomy (PD) with the possible addition of neoadjuvant or adjuvant therapy is the standard of care in the United States for adenocarcinoma originating in the pancreatic head, neck, and uncinate process. We reviewed 1423 patients who underwent a PD for a malignancy originating in the pancreas at our institution between 1970 and 2006. We examined 1175 PDs for ductal adenocarcinomas in greater detail. Eighteen different histological types of pancreatic cancer were identified; the most common diagnoses included ductal adenocarcinoma, neuroendocrine carcinoma, and IPMN with invasive cancer. Patients with ductal adenocarcinoma were analyzed in detail. The median age was 66 years, with patients in the present decade significantly older (68 years), on average, than patients in the three prior decades (e.g., 60 years in 1970, P=0.02). The median tumor diameter was 3 cm; 42% of the resections had positive margins and 78% had positive lymph nodes. The perioperative morbidity was 38%. The median postoperative stay declined over time, from 16 days in the 1980s to 8 days in the 2000s (P<0.001). The perioperative mortality declined from 30% in the 1970s to 1% in the 2000s (P<0.001). The median survival for all patients with ductal adenocarcinoma was 18 months (1-year survival =65 %, 2-year survival =37%, 5-year survival =18%). In a Cox proportional hazards model, pathological factors having a significant impact on survival included tumor diameter, resection margin status, lymph node status, and histologic grade. This is the largest single-institution experience with PD for pancreatic cancer. Patients who have cancers with favorable pathological features have a statistically significant improved long-term survival.

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Authors and Affiliations

  1. From the Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland

    Jordan M. Winter M.D., John L. Cameron M.D., Kurtis A. Campbell M.D., Meghan A. Arnold M.D., David C. Chang Ph.D., M.B.A., M.P.H., JoAnn Coleman C.R.N.P., Mary B. Hodgin C.M.S.R.N., Richard D. Schulick M.D. & Michael A. Choti M.D.

  2. the Department of pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland

    Ralph H. Hruban M.D.

  3. Department of Surgery, Thomas Jefferson University, 1015 Walnut St., Suite 620, 19107, Philadelphia, PA

    Patricia K. Sauter C.R.N.P. & Charles J. Yeo M.D.

  4. Department of Surgery, University of Texas Medical Branch, Galveston, Texas

    Taylor S. Riall M.D.

  5. Department of Surgery, Indiana University, Indianapolis, Indiana

    Keith D. Lillemoe M.D.

Authors
  1. Jordan M. Winter M.D.
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  2. John L. Cameron M.D.
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  4. Meghan A. Arnold M.D.
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  5. David C. Chang Ph.D., M.B.A., M.P.H.
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  6. JoAnn Coleman C.R.N.P.
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  7. Mary B. Hodgin C.M.S.R.N.
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  8. Patricia K. Sauter C.R.N.P.
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  9. Ralph H. Hruban M.D.
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  10. Taylor S. Riall M.D.
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  11. Richard D. Schulick M.D.
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  12. Michael A. Choti M.D.
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  13. Keith D. Lillemoe M.D.
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  14. Charles J. Yeo M.D.
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Correspondence to Charles J. Yeo M.D..

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Winter, J.M., Cameron, J.L., Campbell, K.A. et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 10, 1199–1211 (2006). https://doi.org/10.1016/j.gassur.2006.08.018

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