title: A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon's contribution to long-term survival in pancreatic cancer.
abstract: Pancreatic cancer has a poor prognosis with complete surgical resection being the only therapy to offer a realistic chance for long-term survival. The aim of this study is to identify surgery-related variables that influence long-term survival. Between 1990 and 2002, 226 consecutive patients (mean age of 64+/-11 years) had resection for pancreatic adenocarcinoma. Prognostic variables in these patients were analyzed using univariate and multivariate analysis. Two hundred four patients (90%) had pancreaticoduodenectomy, 13 patients (6%) had distal pancreatectomy, and 9 patients (4%) had a TP. Stage I disease was present in 50 (22%), stage II disease in 170 (75%), and stage III disease in 6 (3%). R0 resections were achieved in 70%. Operative morbidity was 36% and 30-day mortality was 6%. Actual 1-year, 3-year, and 5-year survival rates were 49% (n=111), 14% (n=31), and 4% (n=9). Using multivariate analysis: tumor size, tumor differentiation, obtaining an R0 resection, and lack of postoperative complications were variables associated with long-term survival. Long-term survival in patients with pancreatic cancer after resection remains poor. Achieving a margin negative resection (R0) with no postoperative complications are prognostic variables that can be affected by the surgeon.
authors.affiliation: Pancreas Research Group, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. tjhoward@iupui.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Howard
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Krug
authors.forename: Jian
authors.initials: J
authors.lastname: Yu
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Jacobson
authors.forename: James A
authors.initials: JA
authors.lastname: Madura
authors.forename: Eric A
authors.initials: EA
authors.lastname: Wiebke
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010193:Pancreaticojejunostomy; D011169:Portal Vein / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis