Skip to main content
SpringerLink
Log in

Prognostic Factors After Resection of Pancreatic Cancer

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to identify important prognostic factors related to the status of a pancreatic tumor, its treatment, and the patient’s general condition.

Methods

Between April 1992 and December 2006, 140 patients underwent a pancreatic resection for invasive ductal carcinoma. Prognostic factors were defined by univariate and multivariate analyses.

Results

The study included 103 tumors in the head of the pancreas and 37 tumors in the body or tail. The median survival time and the actuarial 5-year survival rate for all patients were 14.5 months and 12.3%, respectively. Using the significant prognostic factors identified by univariate analysis, multivariate analysis revealed that a preoperative serum CA19-9 concentration >100 U/ml (HR = 1.84, p = 0.0074), a tumor size >3 cm (HR = 1.74, p = 0.0235), venous involvement (HR = 2.39, p = 0.0006), a transfusion requirement of ≥1000 ml (HR = 2.23, p = 0.0006), and a serum albumin concentration on 1 postoperative month (1POM) < 3 g/dl (HR = 2.40, p = 0.0009) were significant adverse prognostic factors. The presence of hypoalbuminemia on 1POM significantly correlated with a longer surgical procedure (p = 0.0041), extended nerve plexus resection around the superior mesenteric artery (p = 0.0456), and a longer postoperative hospital stay (p = 0.0063).

Conclusion

To improve long-term survival, preserving the patient’s general condition by performing a curative resection with a short operation time and minimal blood loss should be the most important principle in the surgical treatment of pancreatic cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sohn TA, Yeo CJ, Cameron JL et al (2000) Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4:567–579

    Article  PubMed  CAS  Google Scholar 

  2. Cleary SP, Gryfe R, Guindi M et al (2004) Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg 198:722–731

    Article  PubMed  Google Scholar 

  3. Han SS, Jang JY, Kim SW et al (2006) Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas 32:271–275

    Article  PubMed  Google Scholar 

  4. Moon HJ, An JY, Heo JS et al (2006) Predicting survival after surgical resection for pancreatic ductal adenocarcinoma. Pancreas 32:37–43

    Article  PubMed  Google Scholar 

  5. Matsuno S, Egawa S, Fukuyama S et al (2004) Panreatic cancer registry in Japan: 20 years of experience. Pancreas 28:219–230

    Article  PubMed  Google Scholar 

  6. Riall TS, Cameron JL, Lillemoe KD et al (2005) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma–Part 3: update on 5-year survival. J Gastrointest Surg 9:1191–1206

    Article  PubMed  Google Scholar 

  7. Pedrazzoli S, DiCarlo V, Dionigi R et al (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas. A multicenter, prospective, randomized study. Ann Surg 228:508–517

    Article  PubMed  CAS  Google Scholar 

  8. Farnell MB, Pearson RK, Sarr MG et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in respectable pancreatic head adenocarcinoma. Surgery 138:618–630

    Article  PubMed  Google Scholar 

  9. Shimada K, Sano T, Sakamoto Y et al (2006) Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol 13:1569–1578

    Article  PubMed  Google Scholar 

  10. Nagakawa T, Kayahara M, Ueno K et al (1992) A clinicopathologic study on neural invasion in cancer of the pancreatic head. Cancer 69:930–935

    Article  PubMed  CAS  Google Scholar 

  11. Nakao A, Harada A, Nonami T et al (1996) Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 12:357–361

    Article  PubMed  CAS  Google Scholar 

  12. Neoptolemos JP, Stocken DD, Friess H et al (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350:1200–1210

    Article  PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. Howard TJ, Krug JE, Yu J et al (2006) A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg 10:1338–1346

    Article  PubMed  Google Scholar 

  15. Rey-Ferro M, Castaño R, Orozco O et al (1997) Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition 13:878–881

    Article  PubMed  CAS  Google Scholar 

  16. Marrelli D, Roviello F, De Stefano A et al (2000) Surgical treatment of gastrointestinal carcinomas in octogenarians: risk factors for complications and long-term outcome. Eur J Surg Oncol 26:371–376

    Article  PubMed  CAS  Google Scholar 

  17. Marrelli D, Pedrazzani C, Neri A et al (2007) Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol 14:25–33

    Article  PubMed  Google Scholar 

  18. Gibbs J, Cull W, Henderson W et al (1999) Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg 134:36–42

    Article  PubMed  CAS  Google Scholar 

  19. Palma S, Cosano A, Mariscal M et al (2007) Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery. Br J Surg 94:369–375

    Article  PubMed  CAS  Google Scholar 

  20. Japan Pancreas Society (2003) Classification of pancreatic carcinoma, 2nd English edn. Kanehara, Tokyo

  21. Misuta K, Shimada H, Miura Y et al (2005) The role of splenomesenteric vein anastomosis after division of the splenic vein in pancreatoduodenectomy. J Gastrointest Surg 9:245–253

    Article  PubMed  Google Scholar 

  22. Miura Y, Ueda M, Kunihiro O et al (2004) Hepatic arterial infusion therapy for pancreatic cancer. Gan To Kagaku Ryoho 31:195–198

    PubMed  Google Scholar 

  23. Wakefield CH, Carey PD, Foulds S et al (1993) Changes in major histocompatibility complex class II expression in monocytes and T cells of patients developing infection after surgery. Br J Surg 80:205–209

    Article  PubMed  CAS  Google Scholar 

  24. Spolarics Z, Siddiqi M, Siegel JH et al (2003) Depressed interleukin-12-producing activity by monocytes correlates with adverse clinical course and a shift toward Th2-type lymphocyte pattern in severely injured male trauma patients. Crit Care Med 31:1722–1729

    Article  PubMed  CAS  Google Scholar 

  25. Hensler T, Hecker H, Heeg K et al (1997) Distinct mechanisms of immunosuppression as a consequence of major surgery. Infect Immun 65:2283–2291

    PubMed  CAS  Google Scholar 

  26. Edna TH, Bjerkeset T (1998) Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer. Dis Colon Rectum 41:451–459

    Article  PubMed  CAS  Google Scholar 

  27. Amato AC, Pescatori M (1998) Effect of perioperative blood transfusions on recurrence of colorectal cancer: meta-analysis stratified on risk factors. Dis Colon Rectum 41:570–585

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Michio Ueda, Itaru Endo, Masayuki Nakashima, Yuta Minami, Kazuhisa Takeda, Kenichi Matsuo, Yasuhiko Nagano, Kuniya Tanaka, Yasushi Ichikawa, Shinji Togo, Chikara Kunisaki & Hiroshi Shimada

Authors
  1. Michio Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Itaru Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayuki Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuta Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuhisa Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenichi Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuhiko Nagano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kuniya Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasushi Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shinji Togo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chikara Kunisaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroshi Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michio Ueda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ueda, M., Endo, I., Nakashima, M. et al. Prognostic Factors After Resection of Pancreatic Cancer. World J Surg 33, 104–110 (2009). https://doi.org/10.1007/s00268-008-9807-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-008-9807-2

Keywords

Search

Navigation