Long‐term Results of Partial Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreatic Head: 25‐Year Experience

Abstract

The prognosis of patients who undergo resection for pancreatic ductal adenocarcinoma with curative intention is generally poor unless they have early-stage disease. Based on our 25-year experience, the results of 194 patients after a standardized Kausch-Whipple resection for adenocarcinoma of the pancreatic head were analyzed and the prognostic factors were evaluated. Between 1972 and 1998 a total of 221 patients were diagnosed for ductal adenocarcinoma of the pancreatic head, and 194 of them subsequently underwent a standardized Kausch-Whipple resection. Long-term results and prognostic factors were examined by multivariate and univariate analyses. The overall postoperative mortality was 3.09%, and the morbidity was 29.9%. By multivariate analysis only curative resection (R0) was significantly related to a favorable prognosis ( p < 0.0001). Furthermore, in case of a curative resection, the presence of lymph node metastases showed prognostic significance in the multivariate analysis ( p = 0.005). Cumulative survival analysis revealed a 5-year survival rate of 25.4%, a 7-year survival rate of 12.3%, and a 10-year survival rate of 8.2% for patients who underwent curative resection (R0) for adenocarcinoma of the pancreatic head. We demonstrated that the R0 status is the only independent prognostic factor after surgery for adenocarcinoma of the pancreatic head. In the case of a curative resection, the presence of lymph node metastases is of prognostic relevance. In view of considerable surgical morbidity and mortality, resection for cancer of the pancreatic head is the only option if the lesion is resectable. We concluded that surgical treatment is "as good as it gets," as extended techniques have not proved to produce better results.

Loss of BNIP3 expression is a late event in pancreatic cancer contributing to chemoresistance and worsened prognosis

“…Clinically, PDAC is often diagnosed at a late stage, when local invasion of vital structures and distant metastasis has already precluded curative resection. Consequently, only B10-20% of the patients are candidates for surgery at the time of diagnosis, of which only approximately 25% will survive for more than 5 years (Yeo et al, 1997;Richter et al, 2003;Wagner et al, 2004). Moreover, PDAC is often highly resistant to the currently available chemotherapeutics as well as radiotherapy (Klinkenbijl et al, 1999;Neoptolemos et al, 2004).…”

Audit of 62 cases of pancreatic resections for pancreatic cancer

“…1,4,5 Current scenario in such a tricky situation is a difficult proposition as outcome with other alternative therapies are not acceptable in terms of survival and quality of life. [6][7][8] Some recent reports show improved survival with Gemcitabine as a first line of therapy. 9 In the present series males are the sufferers of pancreatic cancer, out of 62 patients, 48 (77.41%) males, 14 patients (22.59%) females, age group was 33 to 65 years with mean age between 45 to 55 years.…”

“…4,5 When surgical resection was compared with radio chemotherapy for resectable pancreatic cancer, patients in operative group done fairly well with median survival of 17 months versus 11 months in chemoradiation group. 6,7 Few studies report improvements especially with regard to quality of life, are primarily due to use of gemcitabine as first line chemotherapy. 8 Standardized surgical treatment for head of pancreas cancer, duodenal cancer, distal cholangiocarcinoma, periampullary cancer was Whipple's or it's pylorus preserving modification.…”

Mesopancreas in Pancreatic Cancer: Where do We Stand – Review of Literature

“…Complete surgical resection with R0 negative margins leads to 5 year survival rate of 5 to 20 %. Various studies showed the rate of noncurative resections of 15-35 % [2][3][4][5], but with modified pathological examination (R1/R2) revealed the rate of R1 resection was higher ranging from 76-85 % [6][7][8][9]. Also autopsy studies in patients who died with pancreatic cancer showed 100 % local recurrence.…”