Pancreatic Cancer Resection, a Single Center Experience

Abstract

Purpose: Pancreatic cancer has a poor prognosis with surgical resection being the only available therapy offering a chance for long-term survival. Over the past 20 years, the literature has documented a dramatic decrease in the postoperative morbidity and mortality rates associated with pancreatic resections with overall 5-year survival reported up to 30%. The aim of this study is to describe our local experience. Methods: Between 2000 and 2010, 78 patients had a pancreatic tumor resection in CHUS hospital Hôtel-Dieu and Fleurimont. We retrospectively analyzed 34 patients who had a pancreatic resection for adenocarcinoma and 44 patients who had a pancreatic resection for other pancreatic tumors. The survival was estimated with Kaplan-Meier plots. Results: The mean age of patients was 63 years. Nine surgeons did these 78 resections. 94% of patients had an abdominal CAT scan and 53% had an endoscopic ultrasound evaluation preoperatively. Whipple procedure was performed on 61 patients, 11 had distal pancreatectomy and 6 had a total pancreatectomy. Of patients with adenocarcinoma, 62% had an R0 resection and 57% had regional lymph node metastasis on pathological examination. Postoperative 60-day mortality for all patients was 7.7% (6/78). Significant postoperative morbidity was observed in 60% of patients and 9% had a pancreatic fistula. Their median hospital stay was 26 days. Of patients with adenocarcinoma, 43% had adjuvant chemotherapy and 23% had adjuvant radiotherapy as well. The patients median survival for all tumors was 30 months and of 12.5 months for patients with pancreatic adenocarcinoma. Their 5-year survival was estimated to 44% for all tumors and 15% for the pancreatic adenocarcinoma. Conclusion: In order to improve our long-term survival, we must improve our preoperative evaluation to better identify patients with positive lymph nodes. We should reduce number of surgeons performing pancreatectomies in order to achieve more R0 resections and lower postoperative morbidity and mortality. Those strategies will hopefully allow more patients to be eligible for adjuvant therapies and improve overall survival.Figure: No Caption available.