Abstract
Introduction
Patients with pancreatic adenocarcinoma have poor survival. Presumably, tumors in the body or tail of the pancreas, due to paucity of symptoms, present later than patients with tumors in the head of the pancreas. This study was undertaken to determine if tumors amenable to complete extirpation by distal pancreatectomy/splenectomy have worse survival when compared to their proximal counterparts.
Methods
Since 1992, patients undergoing pancreaticoduodenectomy or distal pancreatectomy/splenectomy for pancreatic adenocarcinoma have been prospectively followed. The impact of resection was evaluated using a survival curve analysis (Mantel–Cox). Data are presented as median, mean ± SD.
Results
Two hundred twenty patients underwent pancreaticoduodenectomy and 33 patients underwent distal pancreatectomy/splenectomy for pancreatic adenocarcinoma. Comparing overall survival, there was not a significant difference between patients undergoing pancreaticoduodenectomy (16.8 months, 25.6 ± 26) and distal pancreatectomy/splenectomy (15.2 months, 19.7 ± 18.6), p = 0.34. Patients undergoing distal pancreatectomy/splenectomy had significantly larger tumors (4 cm, 5 ± 2.3) compared to patients undergoing pancreaticoduodenectomy (3 cm, 3 ± 1.4), p = 0.005.
Conclusion
Long-term survival after resection of pancreatic adenocarcinoma is poor despite the location within the pancreas. Complete tumor extirpation continues to be an independent predictor of survival, regardless of operation undertaken, despite larger tumors for patients who undergo distal pancreatectomy/splenectomy.
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References
Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin 2009; 59(4):225–49.
Mukaiya M, Hirata K, Satoh T, et al. Lack of survival benefit of extended lymph node dissection for ductal adenocarcinoma of the head of the pancreas: retrospective multi-institutional analysis in Japan. World J Surg 1998; 22(3):248–52; discussion 252–3
Henne-Bruns D, Vogel I, Luttges J, et al. Ductal adenocarcinoma of the pancreas head: survival after regional versus extended lymphadenectomy. Hepatogastroenterology 1998; 45(21):855–66.
Johnson CD, Schwall G, Flechtenmacher J, Trede M. Resection for adenocarcinoma of the body and tail of the pancreas. Br J Surg 1993; 80(9):1177–9.
Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 1996; 223(5):506–11; discussion 511–2
Moon HJ, An JY, Heo JS, et al. Predicting survival after surgical resection for pancreatic ductal adenocarcinoma. Pancreas 2006; 32(1):37–43.
Hernandez J, Mullinax J, Clark W, et al. Survival after pancreaticoduodenectomy is not improved by extending resections to achieve negative margins. Ann Surg 2009; 250(1):76–80.
Cleary SP, Gryfe R, Guindi M, et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg 2004; 198(5):722–31.
Raut CP, Tseng JF, Sun CC, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 2007; 246(1):52–60.
Toomey P, Hernandez J, Morton C, et al. Resection of portovenous structures to obtain microscopically negative margins during pancreaticoduodenectomy for pancreatic adenocarcinoma is worthwhile. Am Surg 2009; 75(9):804–9; discussion 809–10
Varadhachary GR, Tamm EP, Abbruzzese JL, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 2006; 13(8):1035–46.
Verbeke CS. Resection margins and R1 rates in pancreatic cancer--are we there yet? Histopathology 2008; 52(7):787–96.
Wade TP, Virgo KS, Johnson FE. Distal pancreatectomy for cancer: results in U.S. Department of Veterans Affairs hospitals, 1987–1991. Pancreas 1995; 11(4):341–4
Christein JD, Kendrick ML, Iqbal CW, et al. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg 2005; 9(7):922–7.
Povoski SP, Karpeh MS, Jr., Conlon KC, et al. Preoperative biliary drainage: impact on intraoperative bile cultures and infectious morbidity and mortality after pancreaticoduodenectomy. J Gastrointest Surg 1999; 3(5):496–505.
Pisters PW, Hudec WA, Hess KR, et al. Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg 2001; 234(1):47–55.
Dalton RR, Sarr MG, van Heerden JA, Colby TV. Carcinoma of the body and tail of the pancreas: is curative resection justified? Surgery 1992; 111(5):489–94.
Nordback IH, Hruban RH, Boitnott JK, et al. Carcinoma of the body and tail of the pancreas. Am J Surg 1992; 164(1):26–31.
Larson DB, Johnson LW, Schnell BM, et al. National trends in CT use in the emergency department: 1995–2007. Radiology; 258(1):164–73
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Toomey, P., Hernandez, J., Golkar, F. et al. Pancreatic Adenocarcinoma: Complete Tumor Extirpation Improves Survival Benefit Despite Larger Tumors for Patients Who Undergo Distal Pancreatectomy and Splenectomy. J Gastrointest Surg 16, 376–381 (2012). https://doi.org/10.1007/s11605-011-1765-6
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DOI: https://doi.org/10.1007/s11605-011-1765-6