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

BMC Surgery

Research Article

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

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

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

DOI  :  10.1186/s12893-015-0110-5

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

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsWe 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.ResultsFour 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.ConclusionPatients 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】

CC BY   
© Ruess et al. 2015