Outcomes of Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma in the Netherlands: A Nationwide Retrospective Analysis.
BACKGROUND
Large multicenter series on outcomes and predictors of survival after distal pancreatectomy (DP) for pancreatic ductal adenocarcinoma (PDAC) are scarce.


METHODS
Adults who underwent DP for PDAC in 17 Dutch pancreatic centers between January 2005 and September 2013 were analyzed retrospectively. The primary outcome was survival, and predictors of survival were identified using Cox regression analysis.


RESULTS
In total, 761 consecutive patients after DP were assessed, of whom 620 patients were excluded because of non-PDAC histopathology (n = 616) or a lack of data (n = 4), leaving a total of 141 patients included in the study [45 % (n = 63) male, mean age 64 years (SD = 10)]. Multivisceral resection was performed in 43 patients (30 %) and laparoscopic resection was performed in 7 patients (5 %). A major complication (Clavien-Dindo score of III or higher) occurred in 46 patients (33 %). Mean tumor size was 44 mm (SD 23), and histopathological examination showed 70 R0 resections (50 %), while 30-day and 90-day mortality was 3 and 6 %, respectively. Overall, 63 patients (45 %) received adjuvant chemotherapy. Median survival was 17 months [interquartile range (IQR) 13-21], with a median follow-up of 17 months (IQR 8-29). Cumulative survival at 1, 3 and 5 years was 64, 29, and 22 %, respectively. Independent predictors of worse postoperative survival were R1/R2 resection [hazard ratio (HR) 1.6, 95 % confidence interval (CI) 1.1-2.4], pT3/pT4 stage (HR 1.9, 95 % CI 1.3-2.9), a major complication (HR 1.7, 95 % CI 1.1-2.5), and not receiving adjuvant chemotherapy (HR 1.5, 95 % CI 1.0-2.3).


CONCLUSIONS
Survival after DP for PDAC is poor and is related to resection margin, tumor stage, surgical complications, and adjuvant chemotherapy. Further studies should assess to what extent prevention of surgical complications and more extensive use of adjuvant chemotherapy can improve survival.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Thijs
T
de Rooij
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Johanna A
JA
Tol
Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Casper H
CH
van Eijck
Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Djamila
D
Boerma
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Bert A
BA
Bonsing
Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
Koop
K
Bosscha
Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Ronald M
RM
van Dam
Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
Marcel G
MG
Dijkgraaf
Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Michael F
MF
Gerhards
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Harry
H
van Goor
Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
Erwin
E
van der Harst
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Ignace H
IH
de Hingh
Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
Geert
G
Kazemier
Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Joost M
JM
Klaase
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
I Quintus
IQ
Molenaar
Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
Gijs A
GA
Patijn
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Hjalmar C
HC
van Santvoort
Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
Joris J
JJ
Scheepers
Department of Surgery, Amphia Hospital, Breda, The Netherlands.
George P
GP
van der Schelling
Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Egbert
E
Sieders
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Olivier R
OR
Busch
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. m.g.besselink@amc.uva.nl.
Marc G
MG
Besselink
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate