Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Abstract

Background: It is supposed that a prolonged lifetime will be associated with increased incidence of PDAC among the elderly. Some studies show a tendency toward decreased survival in the elderly patients following pancreatoduodenectomy for PDAC. The aim of this study was to evaluate factors, influencing survival following pancreatoduodenectomy for PDAC in different age groups. Methods: Data of 251 patients after pancreatoduodenectomy for PDAC between 1999 and 2012 were analyzed. The Kaplan-Meier method and log-rank test were used to calculate survival and to compare differences between groups. The Cox proportional hazard model was applied to indentify independent prognosticators. Results: The overall median survival was 14.9 months. Postoperative morbidity was 25.5% with a 5.1% mortality rate. No significant differences in the overall morbidity (22.4 vs. 29.6%) or mortality (2.8 vs. 8.3%) rates were observed between different patients' age groups (<70 years and >70 years). Multivariate analysis revealed R1 resection (HR 1.76) and poor tumor differentiation (G3-G4) (HR 1.48) were independent negative factors for survival in patients <70 years. Lymph-node metastases (N1) - HR 4.89 and perineural invasion - HR 2.73 were independent prognosticators in the elderly. Conclusions: Our study highlighted different factors influencing long-term survival after pancreatoduodenectomy: R1 resection and poor tumor differentiation (G3-G4) were independent negative factors for survival in patients <70 years, while perineural invasion and lymph-node metastases result in worse survival among the elderly.

Dynamic Perfusion Computed Tomography and Apparent Diffusion Coefficient as Potential Markers for Poorly Differentiated Pancreatic Adenocarcinoma

“…There are several tumor-related prognostic factors for PDAC, including tumor differentiation, vascular invasion, perineural invasion, lymph node metastasis, and systemic spread. Among these, the tumor grade appears to be one of the most important predictors of survival [6, 7]. It is agreed that pathological confirmation is not required in an operable pancreatic tumor; consequently, the latter variable remains unknown prior to surgery.…”

Age does not affect complications and overall survival rate after pancreaticoduodenectomy: Single-center experience and systematic review of literature

“…A total of 21 studies were identified (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). A total of 6,933 PDs were collected, and of these, 1,931 PDs (27.9%) were performed in elderly patients.…”

Preoperative Endoscopic Biliary Drainage May Negatively Impact Survival Following Pancreatoduodenectomy for Ampullary Cancer

“…The current study presents a median survival rate of 109.1 months, corresponding to the data from other high volume centres [9,13] . Five-year (58.4%) and 10-year (39.5%) actuarial survival rates indicate carcinoma of ampulla of Vater having probably one of the best overall survival rates among periampullary carcinomas, especially as compared to the carcinoma of the head of the pancreas [14,15] . This can be attributed to earlier presentation because of the anatomic location of the tumour, and by the difference in biological aggressiveness compared with pancreatic adenocarcinoma.…”