Abstract
BackgroundSurgery remains the only curative option for the treatment of pancreatic adenocarcinoma (PDAC). The goal of this study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head.MethodsThe data from 195 patients who underwent pancreatic head resection for PDAC between 1993 and 2011 in our center were retrospectively analyzed. The prognostic factors for survival after operation were evaluated using multivariate analysis.ResultsThe head resection surgeries included 69.7% pylorus-preserving pancreatoduodenectomies (PPPD) and 30.3% standard Kausch-Whipple pancreatoduodenectomies (Whipple). The overall mortality after pancreatoduodenectomy (PD) was 4.1%, and the overall morbidity was 42%. The actuarial 3- and 5-year survival rates were 31.5% (95% CI, 25.04%-39.6%) and 11.86% (95% CI, 7.38%-19.0%), respectively. Univariate analyses demonstrated that elevated CEA (p = 0.002) and elevated CA 19–9 (p = 0.026) levels, tumor grade (p = 0.001) and hard texture of the pancreatic gland (p = 0.017) were significant predictors of a poor survival. However, only CEA >3 ng/ml (p < 0.005) and tumor grade 3 (p = 0.027) were validated as significant predictors of survival in multivariate analysis.ConclusionsOur results suggest that tumor marker levels and tumor grade are significant predictors of poor survival for patients with pancreatic head cancer. Furthermore, hard texture of the pancreatic gland appears to be associated with poor survival.
Highlights
Surgery remains the only curative option for the treatment of pancreatic adenocarcinoma (PDAC)
The present study reports the short- and long-term outcome of 195 consecutive pancreatic head resections due to pancreatic cancer from a single German pancreatic center
An obstructive jaundice appeared on average 4 weeks before the operation (± 2.3 weeks) in 159 patients (81.5%), and 139 of the patients were preoperatively treated with a biliary stent (71.3%)
Summary
Surgery remains the only curative option for the treatment of pancreatic adenocarcinoma (PDAC). The goal of this study was to investigate the clinical outcome and prognostic factors in patients after resection for ductal adenocarcinoma of the pancreatic head. The prognosis for patients with cancer of the pancreatic head remains poor. Tumor resection is the only therapeutic option to achieve long-term survival. Only a small number of patients (30-40%) present a resectable tumor at the time of diagnosis. The overall 5-year survival after pancreatic head resection for cancer ranges between 10 and 25% [1,2,3]. Adjuvant chemotherapy, which improves patient survival, is routinely used [4,5].
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