title: Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma.
abstract: BACKGROUND
  Actual 5-year survival rates of 10-18% have been reported for patients with resected pancreatic adenocarcinoma (PC), but the use of multimodality therapy was uncommon in these series. We evaluated long-term survival and patterns of recurrence in patients treated for PC with contemporary staging and multimodality therapy.
  
  
  METHODS
  We analyzed 329 consecutive patients with PC evaluated between 1990 and 2002 who underwent resection. Each received a multidisciplinary evaluation and a standard operative approach. Pre- or postoperative chemotherapy and/or chemoradiation were routine. Surgical specimens of 5-year survivors were re-reviewed. A multivariate model of factors associated with long-term survival was constructed.
  
  
  RESULTS
  Patients underwent pancreaticoduodenectomy (n = 302; 92%), distal (n = 20; 6%), or total pancreatectomy (n = 7; 2%). A total of 108 patients (33%) underwent vascular reconstruction, 301 patients (91%) received neoadjuvant or adjuvant therapy, 157 specimens (48%) were node positive, and margins were microscopically positive in 52 patients (16%). Median overall survival and disease-specific survival was 23.9 and 26.5 months. Eighty-eight patients (27%) survived a minimum of 5 years and had a median overall survival of 11 years. Of these, 21 (24%) experienced recurrence, 7 (8%) after 5 years. Late recurrences occurred most frequently in the lungs, the latest at 6.7 years. Multivariate analysis identified disease-negative lymph nodes (P = .02) and no prior attempt at resection (P = 0.01) as associated with 5-year survival.
  
  
  CONCLUSIONS
  Our 27% actual 5-year survival rate for patients with resected PC is superior to that previously reported, and it is influenced by our emphasis on detailed staging and patient selection, a standardized operative approach, and routine use of multimodality therapy.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. katzmh@uci.edu
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
authors.forename: Huamin
authors.initials: H
authors.lastname: Wang
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Rosa F
authors.initials: RF
authors.lastname: Hwang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Gauri
authors.initials: G
authors.lastname: Varadhachary
authors.forename: James L
authors.initials: JL
authors.lastname: Abbruzzese
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D010348:Patient Care Team; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents