Long-term survival (5-20 years) after pancreatectomy for pancreatic ductal adenocarcinoma: a series of 30 patients collected from 3 institutions.
OBJECTIVE
Long-term survival after pancreatectomy for pancreatic duct adenocarcinoma has been rarely reported. Factors influencing survival are still debated. The aim of the study is to report a French multicentric series of long-term survivors after pancreatectomy for pancreatic duct adenocarcinoma.


METHODS
Data of patients who survived >5 years (February 1983-January 2000) were analyzed. All operative specimens were reviewed. Patients with intraductal-papillary-mucinous-neoplasia, cystadenocarcinoma, acinous-adenocarcinoma, neuroendocrine, or mixed tumors were excluded.


RESULTS
Long-term survivors were 20 men and 10 women, with median age of 61 years. Twenty-five patients had pancreaticoduodenectomies (6 pylorus preserving pancreatoduodenectomy [PPPD]), 3 had total pancreaticoduodenectomies, and 2 had splenopancreatectomies. Three patients had portal vein resection, 1 had hepatic artery resection-reconstruction, and 1 had segmentectomy for liver metastasis. All resections were complete macroscopic and microscopic resection (R0). Median tumor size was 30 mm. Tumors were pT2 (n = 1), pT3 (n = 24), pT4 (n = 5), 12 N+, 1 M+. Twenty patients had adjuvant radiotherapy, and 18 had concomitant chemotherapy. Median survival was 7.3 years (range, 5.2-21 years). Nineteen patients are alive, 1 with recurrence and 18 with no evidence of disease (2 had more than 20 years of follow-up). Eleven patients died, 6 from recurrence.


CONCLUSIONS
Pancreatic duct adenocarcinoma can be cured, and long-term survival after R0 curative surgery has become a reality. Long-term survivors did not fulfil the ideal prognostic criteria and even presented with advanced stage.
Adham
Mustapha
M
Department of Hepato-Bilio-Pancreatic Surgery and Transplantation, Lyon University Hospital, Lyon, France. mustapha.adham@chu-lyon.fr
Jaeck
Daniel
D
Le Borgne
Joël
J
Oussoultzouglou
Elie
E
Chenard-Neu
Marie-Pierre
MP
Mosnier
Jean-François
JF
Scoazec
Jean-Yves
JY
Mornex
Françoise
F
Partensky
Christian
C
D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome