The prognostic influence of intrapancreatic tumor location on survival after resection of pancreatic ductal adenocarcinoma

BMC Surgery

Uwe A. Wittel¹  Ulrich T. Hopt¹  Hartwig Riediger²  Olivia Sick¹  Sophia Chikhladze¹  Frank Makowiec¹  Dietrich A. Ruess¹ 

[1] Department of Surgery, University of Freiburg, Freiburg, Germany;Department of Surgery, Vivantes-Humboldt-Clinic, Berlin, Germany

关键词: Outcome;    Survival;    Distal pancreatectomy;    Pancreatoduodenectomy;    Pancreatic cancer;   

Others  :  1234521
DOI  :  10.1186/s12893-015-0110-5

 received in 2015-06-15, accepted in 2015-11-23,  发布年份 2015

【 摘 要 】

Background

The prognosis of pancreatic ductal adenocarcinoma (PDAC) is worse when the tumor is located in the pancreatic body or tail, compared to being located in the pancreatic head. However, for localized, resectable tumors survival seems to be at least similar.

Methods

We analyzed and compared the outcome after pancreatoduodenectomy (PD) and distal pancreatectomy (DP) for PDAC at our institution. Clinical, pathological and survival data from patients undergoing pancreatic resection for PDAC 1994–2014 were explored retrospectively, accessing a prospective pancreatic database. Patients receiving primary total pancreatectomy were excluded.

Results

Four hundred and thirteen patients were treated for PDAC: 347 (84 %) underwent PD and 66 (16 %) DP. Tumors located in the pancreatic body and tail were significantly larger than their counterparts located in the head (30.6 mm vs. 41.2 mm; p < 0.001). However, distal tumors had significantly less nodal involvement (71 % vs. 57 %; p = 0.03). Portal-vein resection (PVR) was performed more often in PD, multivisceral resection (MVR) was more frequent in DP (37 % vs. 14 % and 4 % vs. 29 %; p < 0.001). Rates for negative resection margins and tumor grading were similar. Postoperative complication rates including morbidity, rates of re-operation and mortality were comparable. Long-term outcome revealed no significant difference between PD and DP with 5-year survival rates of 17.8 and 22 % respectively (p = 0.284). Multivariate analysis confirmed positive resection margin, positive nodal status, extended resection (PVR, MVR) and lack of adjuvant/additive chemotherapy as independent risk factors for poor survival after pancreatic resection.

Conclusion

Patients with resectable pancreatic ductal adenocarcinoma located in the body and tail of the pancreas display a similar postoperative oncological outcome despite larger tumors when compared to patients with resectable tumors located in the pancreatic head.

【 授权许可】

   
2015 Ruess et al.

【 图 表 】

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【 参考文献 】

• [1]Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015; 65:5-29.
• [2]Sun H, Ma H, Hong G, Sun H, Wang J. Survival improvement in patients with pancreatic cancer by decade: a period analysis of the SEER database, 1981–2010. Sci Rep. 2014; 4:6747.
• [3]Lau MK, Davila JA, Shaib YH. Incidence and survival of pancreatic head and body and tail cancers: a population-based study in the United States. Pancreas. 2010; 39:458-62.
• [4]Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database 1. J Am Coll Surg. 1999; 189:1-7.
• [5]Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004; 91:586-94.
• [6]Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA et al.. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000; 4:567-79.
• [7]Franko J, Hugec V, Lopes TL, Goldman CD. Survival among pancreaticoduodenectomy patients treated for pancreatic head cancer <1 or 2 cm. Ann Surg Oncol. 2013; 20:357-61.
• [8]Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 2012; 214:46-52.
• [9]Jones OP, Melling JD, Ghaneh P. Adjuvant therapy in pancreatic cancer. World J Gastroenterol. 2014; 20:14733-46.
• [10]Toomey P, Hernandez J, Golkar F, Ross S, Luberice K, Rosemurgy A. Pancreatic adenocarcinoma: complete tumor extirpation improves survival benefit despite larger tumors for patients who undergo distal pancreatectomy and splenectomy. J Gastrointest Surg. 2012; 16:376-81.
• [11]Dalton RR, Sarr MG, van Heerden JA, Colby TV. Carcinoma of the body and tail of the pancreas: is curative resection justified? Surgery. 1992; 111:489-94.
• [12]Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg. 1996; 223:506-11.
• [13]Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Survival after resection for ductal adenocarcinoma of the pancreas. Br J Surg. 1996; 83:625-31.
• [14]Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003; 133:521-7.
• [15]Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg. 2007; 204:244-9.
• [16]Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H et al.. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004; 350:1200-10.
• [17]Moon HJ, An JY, Heo JS, Choi SH, Joh JW, Kim YI. Predicting survival after surgical resection for pancreatic ductal adenocarcinoma. Pancreas. 2006; 32:37-43.
• [18]Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery. 2006; 139:288-95.
• [19]Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW et al.. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg. 2010; 210:779-85.
• [20]Fujita T, Nakagohri T, Gotohda N, Takahashi S, Konishi M, Kojima M et al.. Evaluation of the prognostic factors and significance of lymph node status in invasive ductal carcinoma of the body or tail of the pancreas. Pancreas. 2010; 39:e48-54.
• [21]Paye F, Micelli Lupinacci R, Bachellier P, Boher J-M, Delpero J-R. Distal pancreatectomy for pancreatic carcinoma in the era of multimodal treatment. Br J Surg. 2015; 102:229-36.
• [22]Riediger H, Keck T, Wellner U, Zur Hausen A, Adam U, Hopt UT et al.. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2009; 13:1337-44.
• [23]Ashfaq A, Pockaj BA, Gray RJ, Halfdanarson TR, Wasif N. Nodal counts and lymph node ratio impact survival after distal pancreatectomy for pancreatic adenocarcinoma. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2014; 18:1929-35.
• [24]Parikh PY, Lillemoe KD. Surgical management of pancreatic cancer-distal pancreatectomy. Semin Oncol. 2015; 42:110-22.
• [25]Shoup M, Conlon KC, Klimstra D, Brennan MF. Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg Off J Soc Surg Aliment Tract. 2003; 7:946-52.
• [26]Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2005; 9:922-7.
• [27]Roch AM, Singh H, Turner AP, Ceppa EP, House MG, Zyromski NJ et al.. Extended distal pancreatectomy for pancreatic adenocarcinoma with splenic vein thrombosis and/or adjacent organ invasion. Am J Surg. 2015; 209:564-9.
• [28]Kulemann B, Hoeppner J, Wittel U, Glatz T, Keck T, Wellner UF et al.. Perioperative and long-term outcome after standard pancreaticoduodenectomy, additional portal vein and multivisceral resection for pancreatic head cancer. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2015; 19:438-44.
• [29]Yamamoto J, Saiura A, Koga R, Seki M, Katori M, Kato Y et al.. Improved survival of left-sided pancreas cancer after surgery. Jpn J Clin Oncol. 2010; 40:530-6.
• [30]Kang CM, Kim DH, Lee WJ. Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc. 2010; 24:1533-41.