Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas.
OBJECTIVE
Recent reports have demonstrated improvement in the 5-year actuarial survival for patients with resected ductal adenocarcinoma. The purpose of this study is to determine the factors favoring long-term survival after pancreaticoduodenectomy.


METHODS
Between 1974 and 1995, 75 patients with pancreatic head carcinoma underwent pancreaticoduodenectomy in our department.


RESULTS
Overall postoperative mortality rate was 5. 3% and morbidity was 24%. Median survival following resection was 17 months. Estimated 1-, 2-, and 5-year survival rates were 68%, 46.7%, and 18.7%, respectively. Five-year survival was greater for node-negative than for node-positive patients (41.7% vs. 7.8%, P < 0. 001) and for smaller (<3 cm) than for larger tumors (33.3% vs. 8.8%, P < 0.006). The 5-year survival in patients with negative margins (n = 60) was 23.3%, whereas no patient with positive margins (n = 15) survived at 13 months (P < 0.001). Multivariate analysis, performed by the Cox proportional hazards model, indicated that margin status, lymph node metastasis, tumor size, and poor histological differentiation were independent predictors of poor survival.


CONCLUSIONS
Five-year survival for patients undergoing pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas was 18.7%. Survival was greater in the group of patients with negative lymph nodes, tumor size <3 cm, and negative margin status.
Benassai
G
G
Medicine and Surgery Faculty, Operative Division of General and Oncological Surgery, "Federico II" University of Naples, Naples, Italy.
Mastrorilli
M
M
Quarto
G
G
Cappiello
A
A
Giani
U
U
Forestieri
P
P
Mazzeo
F
F
D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D002768:Choledochostomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015996:Survival Rate