title: The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  The prognosis of pancreatic ductal adenocarcinoma (PDAC) is worse when the tumor is located in the pancreatic body or tail, compared to being located in the pancreatic head. However, for localized, resectable tumors survival seems to be at least similar.
  
  
  METHODS
  We analyzed and compared the outcome after pancreatoduodenectomy (PD) and distal pancreatectomy (DP) for PDAC at our institution. Clinical, pathological and survival data from patients undergoing pancreatic resection for PDAC 1994-2014 were explored retrospectively, accessing a prospective pancreatic database. Patients receiving primary total pancreatectomy were excluded.
  
  
  RESULTS
  Four hundred and thirteen patients were treated for PDAC: 347 (84%) underwent PD and 66 (16%) DP. Tumors located in the pancreatic body and tail were significantly larger than their counterparts located in the head (30.6 mm vs. 41.2 mm; p < 0.001). However, distal tumors had significantly less nodal involvement (71% vs. 57%; p = 0.03). Portal-vein resection (PVR) was performed more often in PD, multivisceral resection (MVR) was more frequent in DP (37% vs. 14% and 4% vs. 29%; p < 0.001). Rates for negative resection margins and tumor grading were similar. Postoperative complication rates including morbidity, rates of re-operation and mortality were comparable. Long-term outcome revealed no significant difference between PD and DP with 5-year survival rates of 17.8 and 22% respectively (p = 0.284). Multivariate analysis confirmed positive resection margin, positive nodal status, extended resection (PVR, MVR) and lack of adjuvant/additive chemotherapy as independent risk factors for poor survival after pancreatic resection.
  
  
  CONCLUSIONS
  Patients with resectable pancreatic ductal adenocarcinoma located in the body and tail of the pancreas display a similar postoperative oncological outcome despite larger tumors when compared to patients with resectable tumors located in the pancreatic head.
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors.forename: Dietrich A
authors.initials: DA
authors.lastname: Ruess
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Makowiec
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Chikhladze
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors.forename: Olivia
authors.initials: O
authors.lastname: Sick
authors.affiliation: Department of Surgery, Vivantes-Humboldt-Clinic, Berlin, Germany.
authors.forename: Hartwig
authors.initials: H
authors.lastname: Riediger
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany.
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Department of Surgery, University of Freiburg, Freiburg, Germany. uwe.wittel@uniklinik-freiburg.de.
authors.forename: Uwe A
authors.initials: UA
authors.lastname: Wittel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome