Factors predicting long-term survival following pancreatic resection for ductal adenocarcinoma of the pancreas: 40 years of experience.
BACKGROUND
Long-term survival after resection for pancreas carcinoma has rarely been reported. Factors influencing long-term survival are still under debate. The aim of this study was to define predictors for long-term survival.


METHODS
Between 1972 and 2004, a total of 415 patients underwent resection. Data were collected in a prospective data base. Data of 360 patients were available for further analysis in 2011. All specimens of long-term survivors were histologically reviewed.


RESULTS
Long-term survivors (n = 69) had a median survival of 91 months. Pathological re-evaluation of all specimens re-confirmed the diagnosis. Predictive factors for long-term survival in univariate analysis were no preoperative biliary stent, low CA 19-9 level, lack of blood transfusion, R0 resection, tumour diameter, and -grading, absence of lymph node or distant metastases, lymphangiosis, and perineural infiltration. Adjuvant chemotherapy showed a significant influence on overall survival but not on long-term survival. In multivariate analysis, lymph node ratio and volume of blood transfusion were predictors of long-term survival.


CONCLUSIONS
Nearly 20% of patients with pancreas carcinoma who undergo surgical resection have a chance of long-term survival. Survival beyond 5 years is predicted by clinical and tumour-specific factors. Adjuvant chemotherapy might prolong overall survival but is, according to these results, unable to contribute to long-term survival. There is still a risk of recurrence after a 5- or even a 12-year mark. Survival beyond 5 or even 12 years, therefore, does not assure cure.
Department of Surgery, Faculty of Medicine Mannheim, University Medical Centre Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
Niloufar
N
Dusch
Christel
C
Weiss
Philip
P
Ströbel
Peter
P
Kienle
Stefan
S
Post
Marco
M
Niedergethmann
D000368:Aged; D001803:Blood Transfusion; D018395:CA-19-9 Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010525:Peripheral Nerves / Q000473:pathology; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012334:RNA, Neoplasm; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D047368:Tumor Burden
D018395:CA-19-9 Antigen; D012334:RNA, Neoplasm