Pancreatectomy for non-pancreatic malignancies results in improved survival after R0 resection

Kimberly A Varker,Christopher Ellison,Peter Muscarella,Kristian Wall,Mark Bloomston

doi:10.1186/1477-7819-5-145

Kimberly A Varker, Christopher Ellison + Show 3 more

Open Access

https://doi.org/10.1186/1477-7819-5-145

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Abstract

BackgroundPancreatectomy has a high morbidity but remains the only chance of cure for pancreatic cancer. Its efficacy for non-pancreatic malignancies is less clear. We reviewed our experience with pancreatectomy for non-pancreatic malignancies to determine outcomes and identify predictors of survival.Patients and methodsThe records of patients who underwent pancreatectomy for non-pancreatic malignancies between 1990 and 2005 were reviewed. Survival curves were constructed using the Kaplan-Meier method and compared using log-rank analysis. Cox proportional hazards was used to identify predictors of survival.Results29 patients (18 M/11 F) with a mean age of 59.9 years (range 29–86) underwent pancreatectomy for non-pancreatic malignancies. 19 (66%) primary malignancies were GI in origin. Most operations were undertaken with curative intent (76%), whereas the remainder was for symptom palliation. Pancreatectomy was completed for metastatic disease in 7 patients (24%) or en bloc to achieve negative margins in 22 patients (76%). Complete (i.e., R0) resection was achieved in 17 (59%). Perioperative mortality was 3%. Median follow-up was 15 months (range 7–172). Median overall survival was 12 months with 1-year survival of 48%. Significant predictors of improved survival by univariate analysis were R0 resection, non-GI primary, and pancreatic metastasectomy (vs. en bloc resection). Only R0 resection was predictive of long-term survival by multivariate analysis (median 21 months vs. 6).ConclusionPancreatic resection for non-pancreatic malignancies can be completed with minimal mortality. However, incomplete resection results in poor overall survival. Pancreatectomy for non-pancreatic malignancies should only be undertaken if complete resection is possible.

Highlights

Pancreatectomy has a high morbidity but remains the only chance of cure for pancreatic cancer
Pancreatic resection for non-pancreatic malignancies can be completed with minimal mortality
World Journal of Surgical Oncology 2007, 5:145 http://www.wjso.com/content/5/1/145 reported to be as high as 11%; the majority of these occur in patients with disseminated intraabdominal metastases [2]

Summary

Introduction

Pancreatectomy has a high morbidity but remains the only chance of cure for pancreatic cancer. We reviewed our experience with pancreatectomy for non-pancreatic malignancies to determine outcomes and identify predictors of survival. World Journal of Surgical Oncology 2007, 5:145 http://www.wjso.com/content/5/1/145 reported to be as high as 11%; the majority of these occur in patients with disseminated intraabdominal metastases [2]. Tumors that most commonly metastasize to the pancreas by blood-borne dissemination include renal cell carcinoma, melanoma, and breast and lung carcinomas. Up to 50% of patients with metastatic lesions are asymptomatic, the metastasis being detected upon routine surveillance for the primary tumor [3]. The differential diagnosis of metastases to the pancreas as compared to primary pancreatic tumors can be difficult. The presence of multiple hypervascular lesions on imaging studies suggests pancreatic metastasis (whereas primary pancreatic tumors are commonly hypovascular), but primary neuroendocrine tumor of the pancreas must be ruled out [3]

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