Analysis of 5-year survivors after a macroscopic curative pancreatectomy for invasive ductal adenocarcinoma.
BACKGROUND
Surgical resections for invasive ductal adenocarcinoma of the pancreas can provide the only chance of cure, although the 5-year survivors are not always equated with cure.


METHODS
A total of 229 who underwent a macroscopic curative pancreatectomy for invasive ductal adenocarcinoma between 1990 and 2003 and have been observed for more than 5 years from the time of resection were retrospectively analyzed. The data of patients who survived more than 5 years were compared with those died within 5 years. The recurrence pattern and factors that influenced an additional 5-year survival in the 5-year survivors were investigated.


RESULTS
Forty patients (17%) survived more than 5 years, and the survival rate for an additional 5 years after surviving 5 years was 72%. A multivariate Cox hazards analysis showed that negative surgical margins status, less frequency of lymphatic invasion, stage </= IIB, and negative lymph node involvement were independent factors associated with long-term survival. Thirty patients (75%) were alive without recurrence, and eight (20%) died of disease within 7.3 years. Intrapancreatic nerve invasion was a significant factor predicting additional long-term survival in the 40 5-year survivors.


CONCLUSIONS
Limited cancer extension with negative lymph node metastases significantly contributes to the chance of surviving more than 5 years. A low incidence of intrapancreatic nerve invasion in the 5-year survivors affects the subsequent favorable survival.
Shimada
Kazuaki
K
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. kshimada@ncc.go.jp
Sakamoto
Yoshihiro
Y
Nara
Satoshi
S
Esaki
Minoru
M
Kosuge
Tomoo
T
Hiraoka
Nobuyoshi
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome