Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Authors

  • Hazem M. Zakaria Department of Hepatopancreatobiliary and Liver Transplantation Surgery, National Liver Institute, Menoufia University, Shebin Elkoom, Menoufia, Egypt
  • Anwar Mohamed Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt
  • Ayman Alsebaey Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt
  • Hazem Omar Department of Diagnostic and Intervention Radiology, National Liver Institute, Menoufia University, Shebin Elkoom, Menoufia, Egypt
  • Dina ELazab Department of Pathology, National Liver Institute, Menoufia University, Egypt
  • Nahla K. Gaballa Department of Anaesthesia and Intensive care unit, National Liver Institute, Menoufia University, Shebin Elkoom, Menoufia, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20185011

Keywords:

Pancreatic duct adenocarcinoma, Pancreaticoduodenectomy, Postoperative complications, Pancreatic fistula, Survival

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.

Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.

Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection margin (P=0.04), and positive lymph nodes in pathology after surgery (P=0.03). In multivariate analysis the independent risk factors for survival were; high preoperative CA 19-9 (P=0.042), tumor size >3cm (P=0.038), poorly differentiated tumor in histopathology (P=0.045).

Conclusions: High tumor marker CA19-9, tumor size, and grade are significant risk factors for poor survival after resection of PDAC and should be taken into account in the selection of patients for surgery to improve the outcome.

References

Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10(9):1199-211.

Distler M, Rückert F, Hunger M, Kersting S, Pilarsky C, Saeger HD, et al. Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinoma. BMC Surg. 2013;13(1):12.

Zakaria HM, Stauffer JA, Raimondo M, Woodward TA, Wallace MB, Asbun HJ. Total pancreatectomy: Short-and long-term outcomes at a high-volume pancreas center. World J Gastrointest Surg. 2016;8(9):634.

Seppänen H, Juuti A, Mustonen H, Haapamäki C, Nordling S, Carpelan-Holmström M, et al. The results of pancreatic resections and long-term survival for pancreatic ductal adenocarcinoma: a single-institution experience. Scand J Surg. 2017;106(1):54-61.

Reni M, Balzano G, Zanon S, Zerbi A, Rimassa L, Castoldi R, et al. Safety and efficacy of preoperative or postoperative chemotherapy for resectable pancreatic adenocarcinoma (PACT-15): a randomised, open-label, phase 2–3 trial. Lancet Gastroenterol Hepatol. 2018.

Åkerberg D, Ansari D, Andersson R. Re-evaluation of classical prognostic factors in resectable ductal adenocarcinoma of the pancreas. World J Gastroenterol. 2016;22(28):6424.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annal Surg. 2004;240(2):205-213.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Hilal MA, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161(3):584-91.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761-8.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20-5.

Roth MT, Berlin JD. Current Concepts in the Treatment of Resectable Pancreatic Cancer. Curr Oncol Rep. 2018;20(5):39.

12-Hartwig W, Werner J, Jäger D, Debus J, Büchler MW. Improvement of surgical results for pancreatic cancer. Lancet Oncol. 2013 Oct;14(11):e476-85.

Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Annal Surg. 2003;237(1):74

Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, et al. Pancreas Cancer Working Group. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138(4):618-30.

Yoon KW, Heo JS, Choi DW, Choi SH. Factors affecting long-term survival after surgical resection of pancreatic ductal adenocarcinoma. J Korean Surg Soc. 2011;81(6):394-401.

Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456-62.

Lu L, Zhang X, Tang G, Shang Y, Liu P, Wei Y, et al. Pancreaticoduodenectomy is justified in a subset of elderly patients with pancreatic ductal adenocarcinoma: A population-based retrospective cohort study of 4,283 patients. Int J Surg. 2018 29;(53):262-8.

Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Annal Surg. 2011;254(2):311-9.

Garcea G, Dennison AR, Pattenden CJ, Neal CP, Sutton CD, Berry DP. Survival following curative resection for pancreatic ductal adenocarcinoma. A systematic review of the literature. JOP. 2008;9(2):99-132.

Cameron JL, Crist DW, Sitzmann JV, Hruban RH, Boitnott JK, Seidler AJ, et al. Factors influencing survival after pancreaticoduodenectomyfor pancreatic cancer. Am J Surg. 1991;161:120-4.

Zakaria HM, Stauffer JA, Harada E, Asbun HJ. Portal and mesenteric vein resection during pancreaticoduodenectomy and total pancreatectomy. Egyptian J Surg. 2017;36(4):352

Worni M, Castleberry AW, Clary BM, Gloor B, Carvalho E, Jacobs DO, et al. Concomitant vascular reconstruction during pancreatectomy for malignant disease: a propensity score-adjusted, population-based trend analysis involving 10,206 patients. JAMA Surg. 2013;148:331-8.

Dumont R, Puleo F, Collignon J, Meurisse N, Chavez M, Seidel L, et al. A single center experience in resectable pancreatic ductal adenocarcinoma: the limitations of the surgery-first approach. Critical review of the literature and proposals for practice update. Acta Gastro-enterologica Belgica. 2017;80(4):451-61.

Bilici A. Prognostic factors related with survival in patients with pancreatic adenocarcinoma. World J Gastroenterol. 2014;20(31):10802-12.

Groot VP, Gemenetzis G, Blair AB, Rivero-Soto RJ, Yu J, Javed AA, et al. Defining and predicting early recurrence in 957 patients with resected pancreatic ductal adenocarcinoma. Annal Surg. 2018 Mar 23.

Hsieh MC, Chang WW, Yu HH, Lu CY, Chang CL, Chow JM, et al. Adjuvant radiotherapy and chemotherapy improve survival in patients with pancreatic adenocarcinoma receiving surgery: adjuvant chemotherapy alone is insufficient in the era of intensity modulation radiation therapy. Cancer Medicine. 2018.

Zins M, Matos C, Cassinotto C. Pancreatic adenocarcinoma staging in the era of preoperative chemotherapy and radiation therapy. Radiology. 2018;287(2):374-390.

Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138(4):618-30.

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Published

2018-11-28

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Original Research Articles