Factors associated with better survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

Abstract

Background: The prognosis of pancreatic adenocarcinoma (PAC) remains poor even after better surgical and perioperative care. The objective is to identify factors associated with better survival in patients with PAC treated with pancreaticoduodenectomy (PDD) at our institution. Methods: Non-concurrent cohort study of patients with LLR at the Hospital Clinico of Universidad Catolica from August 2004 to May 2017. The data were obtained from a database specially designed for hepatobiliary surgery. Major hepatectomies were defined as those with resection of 3 or more segments. Biodemographic, clinical and morbimortality data were analyzed. Results: Seventy patients were analyzed; mean age of 62 ± 11 years; 40 (57%) women. Mean and overall survival was 34 months and 22% at five years for the entire series. Mean resected lymph nodes was 18 ± 9. Twenty-one cases (30%) reached a survival greater than 36 months. At univariate analysis, R0 resection, the absence of positive lymph nodes, the absence of perineural infiltration and early stages (IA, IB and IIA) were associated with survival greater than 36 months (p < 0,05). After multivariable analysis, the absence of diabetes mellitus at the time of diagnosis (OR: 12, 95% CI 1.7–84.3), the absence of perineural infiltration (OR: 7, 95% CI 1.3–36.3) and early stages (OR: 10, 05% CI 2.1–49.1) were demonstrated to be independent factors associated with survival greater than three years. Conclusion: Early stages of the disease, the absence of diabetes mellitus and no perineural infiltration at specimen were associated with survival greater than three years.