Background Recurrence after resection is the main factor for poor survival. The relationship between clinicopathological factors and recurrence after curative distal pancreatectomy for PDAC has rarely been reported separately. Methods Patients with PDAC after left‑sided pancreatectomy between May 2015 and August 2021 were retrospectively identified. Results One hundred forty-one patients were included. Recurrence was observed in 97 patients (68.8%), while 44 (31.2%) patients had no recurrence. The median RFS was 8.8 months. The median OS was 24.9 months. Local recurrence was the predominant first detected recurrence site (n = 36, 37.1%), closely followed by liver recurrence (n = 35, 36.1%). Multiple recurrences occurred in 16 (16.5%) patients, peritoneal recurrence in 6 (6.2%) patients, and lung recurrence in 4 (4.1%) patients. High CA19-9 value after surgery, poor differentiation grade, and positive lymph nodes were found to be independently associated with recurrence. The patients receiving adjuvant chemotherapy had a decreased likelihood of recurrence. In the high CA19-9 value cohort, the median PFS and OS of the patients with or without chemotherapy were 8.0 VS. 5.7 months and 15.6 VS. 13.8 months, respectively. In the normal CA19-9 value cohort, there was no significant difference in PFS with or without chemotherapy (11.7 VS. 10.0 months, P = 0.147). However, OS was significantly longer in the patients with chemotherapy (26.4 VS. 13.8 months, P = 0.019). Conclusions Tumor biologic characteristics, such as T stage, tumor differentiation and positive lymph nodes, affecting CA19-9 value after surgery are associated with patterns and timing of recurrence. Adjuvant chemotherapy significantly reduced recurrence and improved survival. Chemotherapy is strongly recommended in patients with high CA199 after surgery.
Background: Management of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. The advancements in surgical techniques and perioperative management have reduced age-related contraindications for LPD. Past papers have reported that elderly patients undergoing laproscopic pancreatoduodenectomy (LPD) are at an increased risk compared to non-elderly patients. The aim of this paper is to compare a single centre risk of LPD in elderly and non-elderly patients.Methods: Retrospective review (n = 237) of perisurgical outcomes in patients undergoing LPD during the months of September 2012–December 2017. Outcomes in elderly patients (aged ≥75 years) were compared with those in non-elderly patients.Results: In elderly patients, transfer to ICU was more frequent (odds ratio [OR] 6.49, P = 0.001) and mean hospital stay was lengthier (21.4 days compared with 16.6 days, (P = 0.0033) than for non-elderly patients. There was no statistically significant difference in operation time (P=0.494), estimated blood loss (P=0.0519), blood transfusion (P=0.863), decreased gastric emptying (DGE) (P=0.397), abdominal pain (P=0.454), food intake (P=0.241), time to self ambulation (P=1), reoperation (P=0.543), postoperative pancreatic fistula (POPF) grade A (P=0.454), POPF grade B (P=0.736), POPF grade C (P=0.164), hemorrhage (P=0.319), bile leakage (P=0.428), infection (P=0.259), GI bleeding (P=0.286), morbidity (P=0.272) or mortality (P=0.449) between the two groups.Conclusions: Elderly patients who underwent LPD in this study had significantly good overall survival after LPD and similar to young patients . The perioperative and long term outcomes of LPD are not worse .The Both rate of ICU admission and hospital stay increased in elderly patients undergoing LPD when compared with non-elderly ones. LPD can be performed on elderly patients with similar outcomes as younger patients; therefore Age it self should not be a contraindication to LPD for pancreatic cancer, but it suggests that elderly patients with comorbidities should be more stringently selected for surgery.
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