title: A contemporary analysis of survival for resected pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  Survival after a resected pancreatic ductal adenocarcinoma (PDAC) appears to be improving. Yet, in spite of advancements, prognosis remains disappointing. This study analyses a contemporary experience and identifies features associated with survival.
  
  
  METHODS
  Kaplan-Meier analysis was conducted for 424 PDAC resections performed at two institutions (2001-2011). Multivariate analysis was performed to elicit characteristics independently associated with survival.
  
  
  RESULTS
  The median, 1-, and 5-year survivals were 21.3 m, 76%, and 23%, with 30/90-day mortalities of 0.7%/1.7%. 76% of patients received adjuvant therapy. Patients with major complications (Clavien Grade IIIb-IV) survived equivalently to patients with no complications (P = 0.33). The median and 5-year survival for a total pancreatectomy was 32.2 m/49%; for 90 'favourable biology' patients (R0/N0/M0) was 37.3 m/40%; and for IPMN (9% of series) was 21.2 m/46%. Elderly (>75 yo) and nonelderly patients had similar survival. Favorable prognostic features by multivariate analysis include lower POSSUM physiology score, R0 resection, absence of operative transfusion, G1/G2 grade, absence of lymphovascular invasion, T1/T2 stage, smaller tumor size, LN ratio <0.3, and receipt of adjuvant therapy.
  
  
  CONCLUSIONS
  This experience with resected PDAC shows decreasing morbidity and mortality rates along with modestly improving long-term survival, particularly for certain subgroups of patients. Survival is related to pathological features, pre-operative physiology, operative results and adjuvant therapy.
authors.affiliation: Departments of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, 19104, USA.
authors.forename: Russell
authors.initials: R
authors.lastname: Lewis
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Drebin
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: Douglas
authors.initials: D
authors.lastname: Fraker
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: Jenna
authors.initials: J
authors.lastname: Gates
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000367:Age Factors; D000368:Aged; D001900:Boston / Q000453:epidemiology; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality*; D015143:Philadelphia / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome