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Annals of Surgical Oncology

, Volume 22, Issue 4, pp 1160–1167 | Cite as

Improved Long-Term Outcomes After Resection of Pancreatic Adenocarcinoma: A Comparison Between Two Time Periods

  • Pablo E. Serrano
  • Sean P. Cleary
  • Neesha Dhani
  • Peter T. W. Kim
  • Paul D. Greig
  • Kenneth Leung
  • Carol-Anne Moulton
  • Steven Gallinger
  • Alice C. Wei
Pancreatic Tumors

Abstract

Background

Despite reduced perioperative mortality and routine use of adjuvant therapy following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), improvement in long-term outcome has been difficult to ascertain. This study compares outcomes in patients undergoing resection for PDAC within a single, high-volume academic institution over two sequential time periods.

Methods

Retrospective review of patients with resected PDAC, in two cohorts: period 1 (P1), 1991–2000; and period 2 (P2), 2001–2010. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine prognostic factors associated with long-term survival. Survival was evaluated using Kaplan–Meier analyses.

Results

A total of 179 pancreatectomies were performed during P1 and 310 during P2. Perioperative mortality was 6.7 % (12/179) in P1 and 1.6 % (5/310) in P2 (p = 0.003). P2 had a greater number of lymph nodes resected (17 [0–50] vs. 7 [0–31]; p < 0.001), and a higher lymph node positivity rate (69 % [215/310] vs. 58 % [104/179]; p = 0.021) compared with P1. The adjuvant therapy rate was 30 % (53/179) in P1 and 63 % (195/310) in P2 (p < 0.001). By multivariate analysis, node and margin status, tumor grade, adjuvant therapy, and time period of resection were independently associated with overall survival (OS) for both time periods. Median OS was 16 months (95 % confidence interval [CI] 14–20) in P1 and 27 months (95 % CI 24–30) in P2 (p < 0.001).

Conclusions

Factors associated with improved long-term survival remain comparable over time. Short- and long-term survival for patients with resected PDAC has improved over time due to decreased perioperative mortality and increased use of adjuvant therapy, although the proportion of 5-year survivors remains small.

Keywords

Overall Survival Adjuvant Therapy Distal Pancreatectomy Pancreatic Ductal Adenocarcinoma Survival Estimate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Pablo E. Serrano, Sean P. Cleary, Neesha Dhani, Peter T.W. Kim, Paul D. Greig, Kenneth Leung, Carol-Anne Moulton, Steven Gallinger, and Alice C. Wei have no conflicts of interest to disclose for this study. We attest that we have herein disclosed any and all financial or other relationships that could be construed as a conflict of interest and that all sources of financial support for this study have been disclosed.

Supplementary material

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Pablo E. Serrano
    • 1
    • 2
  • Sean P. Cleary
    • 3
    • 6
  • Neesha Dhani
    • 4
    • 6
  • Peter T. W. Kim
    • 5
  • Paul D. Greig
    • 3
    • 6
  • Kenneth Leung
    • 3
  • Carol-Anne Moulton
    • 3
    • 6
  • Steven Gallinger
    • 3
    • 6
  • Alice C. Wei
    • 3
    • 6
    • 7
  1. 1.Department of SurgeryMcMaster UniversityHamiltonCanada
  2. 2.Department of Clinical Epidemiology and Biostatistics, Faculty of Health SciencesMcMaster UniversityHamiltonCanada
  3. 3.Department of Surgery, University Health NetworkUniversity of TorontoTorontoCanada
  4. 4.Department of Medical Oncology and HematologyUniversity of TorontoTorontoCanada
  5. 5.Department of SurgeryBaylor University Medical CenterDallasUSA
  6. 6.Princess Margaret Cancer Center, University Health NetworkTorontoCanada
  7. 7.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada

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