Recurrence after resection for ductal adenocarcinoma of the pancreas (original) (raw)
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Survival after resection for ductal adenocarcinoma of the pancreas
British Journal of Surgery, 1996
A retrospective study was performed of 113 patients who underwent surgical resection of carcinoma of the pancreas from 1970 to 1992. The postoperative mortality rate was 15 per cent (5 per cent in the last 11 years). The actuarial S-year survival rate was 12 per cent. Survival was significantly influenced by age (P:0'03), vascular resection (P:0'02), radicality of operation (P:0'01), number of transfused blood units (P:0'01), tumour differentiation (P:0'002), lymph node status (P:0'001), perineural invasion (P:0'01), tumour size (P:0'008), preoperative diabetes (P:0'001) and stage (P:0'0001).
Clinical and pathologic prognostic factors for curative resection for pancreatic cancer
HPB, 2008
Background. Pancreatic cancer is the fifth leading cause of cancer-related deaths in the world. Operative resection is the only therapeutic option with curative potential for this disease. Objective. The aim of the present study was to correlate clinical and pathologic parameters with survival in patients submitted to pancreatic resection for pancreatic adenocarcinoma. Methods. Surgical resection with curative intent (R0 and R1 resections) was performed in 65 pancreatic cancer patients between 1990 and 2006. The overall results of surgical treatment were retrospectively analyzed and compared with the clinicopathologic features of these patients. Results. Pylorus-preserving pancreatoduodenectomy was performed in 37 patients (56.9%), classic resection in 35.4%, distal pancreatectomy in 4.6% and total pancreatectomy in 3.6%. The inhospital mortality was 5% (three patients). Postoperative complications occurred in 28 patients (43%). Mean survival and five-year survival rate after curative resection were 27 months and 9.0%, respectively. Sex, TNM stage, tumor differentiation, neural invasion, tumor size and involvement of resection margin were significant prognostic factors on univariate analysis. Multivariate analysis showed tumor differentiation and neural invasion as prognostic factors. Conclusion. Patients with pancreatic cancer, even those with poor prognostic factors should be given the opportunity of surgical resection with curative intent.
Experience of Pancreatic Resection for Pancreatic Cancer an Audit of 75 Cases
Scholarly Journal of Surgery, 2018
Introduction: Different pancreatic pathologies, needs resection of pancreatic tissue. Adenocarcinoma of the pancreatic duct is the most frequently seen malignancy, presenting with early metastasis and seen as resistant to alternative treatment regimens currently available [1,2]. Management and handling of such tumors is a complex and challenging task for a surgeon [1-3]. surgical resection offers improved prognosis, with a median survival after resection of 14-20 months and up to 25% 5-year survival rates [4,5]. This study is aimed at presenting data of 75 pancreatic resections for various malignant pancreatic lesions. Methods: This is an ongoing longitudinal study which started in 2009 at teaching institute in central India. Though we had 122 patients for pancreatic resection, only 75 patients were considered suitable for the present study. All patients after admission were thoroughly investigated and then considered for surgery. 53 patients were male and 22 patients were female. Age group was ranging from 34 to 67 years with mean age between 46 to 56 yrs. Spectrum of various malignancies and different types of pancreatic resections were done and results are presented in this study. Results: Pancreatic adenocarcinoma is one of the most aggressive malignancy, responds to surgical treatment better than other alternative modalities. In our series out of 75 patients 32 patients with pancreatic head cancer, 28 patients with Periampullary cancer, 2 patients with duodenal cancer, 8 patients with distal cholangio carcinoma, 1 patient with mucinous cystadenocarcinoma. 4 patients with body and tail of pancreas cancer. Average age 34 to 67 years, 53 males and 22 females. Commonest procedure was Whipple’s operation, and distal pancreatectomy. Survival in our series was 18 -24 months and 5-year survival was 12 % that is seen mainly with Periampullary cancer. Conclusion: Surgery is the only chance of cure or long term survival in pancreatic cancer. Chemo radiation as a primary therapy is ineffective. But some reports suggest the improved quality of life with palliative chemotherapy. Biology of the disease is the king and dictates the outcome, the type of surgical procedure had no impact on survival, nor on morbidity and mortality.
Prognostic factors of long-term survival after resective procedures for pancreatic cancer
Hepato-gastroenterology
Five-year survival rates following surgical resection of pancreatic cancer reported by the leading medical centers do not exceed 25%. It necessitates further extensive research in this area. The aim of the study was to determine prognostic factors of long-term survival after surgical treatment for pancreatic cancer. From 1980 to 1999, 212 patients underwent surgical resection for pancreatic carcinoma. Statistical analysis of prognostic factors of long-term survival after pancreatic cancer surgery estimated by Kaplan-Meier method was carried out using multiple regression model. A group of 212 patients underwent surgery, where 98 had Whipple's resection, 50 Traverso, 35 total pancreatic resections, 25 left subtotal resections, and the remaining 4 segmental pancreatic body resections. Perioperative mortality was below 8%, 5-year survival approximately 15%, increasing to 65% in patients with early cancer. It was observed, that the following prognostic factors influenced the long-ter...
Prognostic factors after surgical resection for pancreatic carcinoma
Journal of Surgical Oncology, 2000
Background and Objectives: Surgical resection offers the only potential cure for pancreatic carcinoma. Several recent series have reported an encouraging increase in 5-year survival rate exceeding 20% and have emphasized the importance of patient selection based on reproducible prognostic factors. The impact on survival of demographic, intraoperative, and histopatologic factors are investigated in this study. Methods: Seventy-three patients with adenocarcinoma of the pancreas, treated at the Department of Surgery of the Catholic University of Rome during 1988-1998, were retrospectively analyzed. Survival data were reviewed, and potential prognostic factors were compared statistically by univariate and multivariate analyses. Results: There was no operative mortality, and the morbidity rate was 37%. Actuarial overall and disease-specific survival rates for all 73 patients were, respectively, 27% and 31% at 3 years and 13% and 21% at 5 years, with a median survival time of 16 months. T stage and nodal status significantly affected survival according to univariate analysis (P ס 0.0017 and 0.04). An impact on survival, even if not of statistical significance, was shown for other pathologic or intraoperative factors. Conclusions: T and nodal stage are the strongest independent predictors of survival. Limited intraoperative transfusion, reduced operative time, and clear margins also may play a role, which requires further confirmation in a larger series.
Outcome of surgical treatment of carcinoma of the pancreas
Tumori
Pancreatic resections for neoplastic diseases have a high risk of severe intra- and postoperative complications and are associated with high mortality rates. They should be performed as a rule in centers specializing in this type of surgery. However, it is becoming increasingly likely that such tumors may have to be treated in surgery units which are not specifically dedicated to pancreatic surgery. The aim of this study was to assess the improvements in clinical results in a non-specialized general surgery setting in the light of the most recent progress in surgical techniques, drug treatments and nutritional support. We analyzed 48 patients with pancreatic cancer treated in our institution over the period from 1980 to 1998: 36 had cancer of the head of the pancreas, 5 of the ampulla, 1 in the second duodenal portion, and 6 of the body-tail. The operations performed consisted of 13 Whipple pancreaticoduodenectomies with cutting and stapling of the distal pancreatic stump at the lev...
General Aspects of Surgical Treatment of Pancreatic Cancer
Digestive Surgery, 1999
Background: Different results and opinions exist concerning the use of a standard or an extended lymphadenectomy, and about the indications for portal vein resection in the surgical treatment of pancreatic cancer. The site of recurrence of pancreatic cancer may help to define the usefulness of different treatments in avoiding local and/or distant recurrences. Methods: From personal experience and a literature review, 841 patients who underwent portal vein resection were collected, and 29 papers reporting the results of extended lymphadenectomy in the surgical treatment of pancreatic cancer were analyzed. A review of the site of relapse according to the surgical treatment, with or without various adjuvant treatments, was performed. Personal experience on survival rate according to the site of relapse (local, distant, local and distant) is also reported. Results: Portal vein resection has been performed without a significant increase in morbidity and mortality rate in a large number of patients. However, its usefulness for increasing the resectability rate and the long-term survival has yet to be established. Extended lymphadenectomy does not increase the morbidity and mortality rate, but conflicting results on long-term survival have been reported. Distant metastases, undetectable by the radiologist and the surgeon, usually kill more than 40% of the resected patients within 12 months. Only lymph node-positive patients with limited undetectable distant metastases seem to benefit from an extended lymphadenectomy. Although many data are lacking, the incidence of the different sites of relapse is the same whatever the surgical and/or adjuvant treatment performed. Overall survival and disease-free survival rate are not affected by the site of relapse. A significantly worse survival rate was observed after the radiological detection of local and distant metastasis than after an only local or only distant metastasis. Conclusion: Portal vein resection and extended lymphadenectomy can be performed without increasing the surgical morbidity and mortality rate. We still have insufficient data to decide which patient can benefit from a more extended procedure. Standardization of operations, terminology, pathological reporting, and follow-up, together with well-designed prospective studies, will help to decide the operation of choice for pancreatic cancer.
The role of surgery for pancreatic cancer: a 12-year review of patient outcome
The Ulster medical journal, 2010
Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival. All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test. 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenoc...
Academic Radiology, 2019
Materials and Methods: Ninety patients with recurrent pancreatic cancer were retrospectively included in the study. 74.4% had pancreatic head tumors (group 1) and 25.6% pancreatic body and/or tail tumor (group 2). The tumor localization, operative technique, TNM stage, the R-status, tumor grade, lymphovascular, and perineural invasion were recorded. Location of local tumor recurrence, lymph node recurrence, or organ metastases were analyzed on the basis of follow-up CT imaging. Results: Mean recurrence time was 17.4 § 13.2 months. The most common recurrence type was local recurrence (84.4%), followed by lymph node (15.5%), liver (14.4%), and lung metastasis (6.7%). The predominant site of local recurrence in pancreatic head tumors was close to superior mesenteric artery, common hepatic artery, and/or celiac artery (57.4%), followed by area defined by portal vein, inferior vena cava, CA or superior mesenteric artery (31.2%). Patients with pancreatic body and/or tail carcinoma had higher incidence (p = 0.003) of metastatic disease comparing to pancreatic head tumors, while resection margin was the most common type of local tumor recurrence, seen in 46.7% cases versus 8.2% of patients with pancreatic head tumors (p < 0.001). Conclusion: The most common recurrence type in patients with resected pancreatic carcinoma was local recurrence along cardinal arteries. The localization of primary tumor influences the type of tumor relapse and site of local recurrence.