Descriptive and Survival Analysis after Pancreatic Surgery in Patients with Ductal Adenocarcinoma of the Pancreas

Abstract

Purpose: Pancreatic ductal adenocarcinoma (PDAC) is considered one of the most aggressive solid tumors. The prognosis is poor and the 5 year survival is 5-7%. Surgical treatment is proven to prolong survival. The aim of the present study is to describe the clinical and epidemiologic characteristics of the patients operated for PDAC. Method: This is a retrospective study (2009-2019) of consecutive patients undergoing pancreatic surgery for PDCA between 2009 and 2019. Clinical, laboratory, radiological, histological, perioperative and survival parameters were evaluated. Results: A total of 27 patients were operated during the period of the study: 85,2 pancreaticoduodenectomy, 11,1%distal pancreatectomy and splenectomy and 3,7% total pancreatectomy, and 7.4% required portal vein resections.). Mean age was 62 years and 59.3% were male. Most patients were ASA III (59,3%). The recurrence rate was 44.4% distributed between local (25.9%), locoregional (22.2%), hepatic (22.2%) and pleural (11.1%) (Table 1). Median overall survival was 26.4 months, and the disease-free survival was 14.2 months. The 1-year and 5-year survival rates were 59.3% and 1.88% (Figure 1). Conclusions: The clinical, morbi-mortality and survival characteristics in our study group were similar to those described in the literature. This study confirms the high morbidity rates after pancreatic surgery and low rates of survival in resectable PDAC.Tabled 1Table 1: Demographic, clinical and perioperative characteristics of the patients with pancreatic resection with ductal adenocarcinoma of the pancreas.CharacteristicsAll patients (n = 27)Age (years)62 ± 4.2Gender Female11 (40.7%) Male16 (59.3%)Comorbidities HTA15 (55.6%) DM 211 (40.7%)Pneumopathy2 (7.4%)Cardiopathy5 (18.5%)Age adjusted Charlson Comorbidity Index5.6 ± 2.5BMI24 ±3.9ASA score II10 (37%) III16 (59.3%) IV1 (3.7%)Preoperative drainage Preoperative ERCP drain16 (59.3%) Preoperative PTC drain4 (14.8%)Procedure Whipple’s23 (85.2%) Distal Pancreatectomy + Splenectomy3 (11.1%) Total Pancreatectomy1 (3.7%)Portal Vein resection2 (7.4%)HistologyTumoral size (mm)25 (25-90)Resection margin R016 (59.3%) R111 (40.7%)Stage AJCC Ia3 (11.1%) Ib6 (22.2%) IIa3 (11.1%) IIb14 (51.8%) III1 (3.7%)Tumor grade G15 (18.5%) G216 (59.3%) G36 (22.2%)Perineural invasión22 (81.5%)Perivascular invasión5 (18.5%)Morbidity15 (44.4%)Clavien-Dindo≤ 26 (11.1%)Major complicactions (Clavien-Dindo> 39 (33.3%)Drainage amylase38 (4 – 30000)Lenght of hospital stay18 (13-47)Adyuvant treatment Chemotherapy11 (68.8%) Chemotherapy + Radiotherapy5 (31.2%)90 days readmission rate6 (22.2%)Overall survival36.1 ± 14.8Desease free survival35.5 ± 15.7 Open table in a new tab