A multi-institutional analysis of factors affecting survival for left-sided pancreatic adenocarcinoma

Abstract

Background: Pancreatic ductal adenocarcinoma of the neck, body and tail (PDAC-NBT) often presents at an advanced stage given lack of discrete clinical symptoms. This study compiles PDAC-NBT resections from multiple institutions and aims to characterize clinicopathologic and surgical factors associated with survival after pancreatectomy. Methods: Patients who underwent distal or subtotal pancreatectomy for PDAC-NBT at five high-volume centers from 2001 to 2016 were retrospectively collected. Clinicopathologic factors were correlated with the primary outcome of overall survival in univariate and multivariate analyses. Results: 330 patients were surgically treated between 2001 and 2016. The majority of patients presented with early stage disease (Stage I-15.9%, Stage II-81.4%, Stage III-1.7%). Twenty-one patients (10.3%) received neoadjuvant therapy and 221 (72.5%) completed adjuvant therapy. Median survival was 26.8 months, with 1-,3-,and 5- year overall survival of 77.1%, 41.2%, and 28.4%. Median follow-up time was 21.7 months. Pathologic findings of lymphovascular invasion (p < 0.0001), perineural invasion (p = 0.0089), and lymph node invasion (p < 0.0001) were significantly associated with worse survival on univariate analysis. Tumor size >1.5 cm (p = 0.0063), lymph node ratio >0.1 (p = 0.0003), and a non-R0 resection (p = 0.0002) were also significantly associated with worse survival. Tumor stage, major surgical complications (Clavien-Dindo ≥3), and local tumor recurrence were independently associated with worse survival on multivariate analysis (p < 0.05). There were no significant associations between survival and operation type, preoperative presenting symptoms, or neoadjuvant or adjuvant therapy. Conclusion: This is the largest series analyzing PDAC-NBT who underwent surgical therapy. Improved survival is associated with favorable tumor biology and operative outcomes.