P-0114 Advances in The Treatment of Resectable Pancreatic Cancer: Lessons Learned from two Decade

Abstract

IntroductionPancreatic adenocarcinoma (PDC) is nowadays recognized as an aggressive malignancy, recent studies have provided a reason for optimism. A trend toward improved overall survival was reported. In addition, progress in surgical technique and perioperative care, in conjunction with the emergence of high volume centers of excellence, have reduced the mortality rate and the severity of complications after pancreatic resection. It is unclear whether progress in the field of pancreatic cancer over the past two decades has translated into a measurable improvement in survival in patients who present with resectable disease outside of a clinical trial. The intent of this investigational design was to focus specifically on changes in oncologic outcome after pancreatic resection for PDC between decades. The end point of the study was to evaluate long-term survival. MethodsFrom 1990 to 2009, 544 patients with histologically proven PDC were resected at the Department of Surgery of the University of Verona. Patients were categorized according to the decade in which they underwent resection (the 90s or 2000s) and trends in short and long-term outcomes were examined. Results544 pancreatic resections were performed for PDC. By decade, there were 114 resections in the 1990s (median=12/year) and 430 in the 2000s (median=41/year). The perioperative mortality has improved since the 1990s (2.6% versus 1.1% in 2000s). The length of hospital stay (LOS) decreased from 16 days in 90s to 10 days in 2000s (p<0.0001). The 1- and 3 year survival rate were 64% and 17% in the first period and 84% and 42% in the second, respectively (P<0.0001). The median disease specific survival significantly increased from 16 to 29 months (P< 0.0001). By multivariable analysis, poor differentiation, lymph node, R1 resection, no adjuvant therapy and the resection performed in the period 1990-2000 were significant independent predictors of poor outcome. Furthermore in order to focus specifically on the oncologic outcome early and intermediate deaths were excluded to minimize confounding factors such as improvements in operative mortality and patient selection. The long-term survival in patients who survived 1 year remained significantly better in the 2000s as compared to the 90s (P <0.0001). ConclusionThe overall survival after resection significantly improved over time. The improvement in mortality and LOS underlines a rising perioperative management. We postulate that improvements in 1-year survival is related to a better surgical outcome and preoperative staging. Whereas the use of an adjuvant therapy justified an improvement in survival realized beyond a year.