title: Clinical and pathologic features influencing survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma.
abstract: OBJECTIVE
  The aim of the study was to determine the clinicopathological features that influence survival in patients with resected pancreatic ductal adenocarcinoma (PDA).
  
  
  METHODS
  The study used a single institution retrospective review of patients undergoing pancreaticoduodenectomy (PD) for PDA from 1993 to 2010.
  
  
  RESULTS
  Two hundred forty-six consecutive cases of resected PDA were identified: 128 males (52 %), median age 68 years. Median hospital length of stay was 8 days and 30-day mortality rate was 2.4 %. There were 101 (41.1 %) postoperative complications, 77 % of which were Dindo-Clavien Grade 3 or less. Overall survival was 85, 63, 25, and 15 % at 6 months, 1 year, 3 years, and 5 years, respectively, with a median survival of 17 months. Multivariate Cox proportional hazard modeling demonstrated lymph node ratio was negatively correlated with survival at all time points. Preoperative hypertension was a poor prognostic factor at 6 months, 3 years, and 5 years. The absence of postoperative complications was protective at 6 months whereas pancreatic leaks were associated with worse survival at 6 months. Abdominal pain on presentation, operative time, and estimated blood loss were also associated with decreased survival at various time points.
  
  
  CONCLUSIONS
  The strongest prognostic variable for short- and long-term survival after PD for PDA is lymph node ratio. Short-term survival is influenced by the postoperative course.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Loyola University, Maywood, IL, USA.
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Weber
authors.forename: Eileen A
authors.initials: EA
authors.lastname: Bock
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hurtuk
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Abood
authors.forename: Jack
authors.initials: J
authors.lastname: Pickleman
authors.forename: Margo
authors.initials: M
authors.lastname: Shoup
authors.forename: Gerard V
authors.initials: GV
authors.lastname: Aranha
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors