title: Pancreatic adenocarcinoma: complete tumor extirpation improves survival benefit despite larger tumors for patients who undergo distal pancreatectomy and splenectomy.
abstract: BACKGROUND
  Patients with pancreatic adenocarcinoma have poor survival. Presumably, tumors in the body or tail of the pancreas, due to paucity of symptoms, present later than patients with tumors in the head of the pancreas. This study was undertaken to determine if tumors amenable to complete extirpation by distal pancreatectomy/splenectomy have worse survival when compared to their proximal counterparts.
  
  
  METHODS
  Since 1992, patients undergoing pancreaticoduodenectomy or distal pancreatectomy/splenectomy for pancreatic adenocarcinoma have been prospectively followed. The impact of resection was evaluated using a survival curve analysis (Mantel-Cox). Data are presented as median, mean ± SD.
  
  
  RESULTS
  Two hundred twenty patients underwent pancreaticoduodenectomy and 33 patients underwent distal pancreatectomy/splenectomy for pancreatic adenocarcinoma. Comparing overall survival, there was not a significant difference between patients undergoing pancreaticoduodenectomy (16.8 months, 25.6 ± 26) and distal pancreatectomy/splenectomy (15.2 months, 19.7 ± 18.6), p = 0.34. Patients undergoing distal pancreatectomy/splenectomy had significantly larger tumors (4 cm, 5 ± 2.3) compared to patients undergoing pancreaticoduodenectomy (3 cm, 3 ± 1.4), p = 0.005.
  
  
  CONCLUSIONS
  Long-term survival after resection of pancreatic adenocarcinoma is poor despite the location within the pancreas. Complete tumor extirpation continues to be an independent predictor of survival, regardless of operation undertaken, despite larger tumors for patients who undergo distal pancreatectomy/splenectomy.
authors.affiliation: Tampa General Hospital Medical Group, 409 Bayshore Blvd, Tampa, FL 33606, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Toomey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Farhaad
authors.initials: F
authors.lastname: Golkar
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D013156:Splenectomy; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden