Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma.
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.
Katz
Matthew H G
MH
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. katzmh@uci.edu
Wang
Huamin
H
Fleming
Jason B
JB
Sun
Charlotte C
CC
Hwang
Rosa F
RF
Wolff
Robert A
RA
Varadhachary
Gauri
G
Abbruzzese
James L
JL
Crane
Christopher H
CH
Krishnan
Sunil
S
Vauthey
Jean-Nicolas
JN
Abdalla
Eddie K
EK
Lee
Jeffrey E
JE
Pisters
Peter W T
PW
Evans
Douglas B
DB
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
D000970:Antineoplastic Agents