Long-term survival after curative resection for pancreatic ductal adenocarcinoma – Surgical treatment

Quarto, Gennaro; Perrotta, S.; Furino, Ermenegildo; Benassai, Giacomo; Amato, Bruno; Bianco, Tommaso; Palma, G.D. De; Forestieri, Pietro

doi:10.1016/j.ijsu.2015.06.050

Cited by 30 publications

(20 citation statements)

References 30 publications

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“…Moreover, pancreatic surgery itself is associated with rather high morbidity and mortality. Factors predicting the survival of pancreatic cancer patients include TNM stage, resection margin, lymph-node ratio (LNR, metastatic lymph nodes divided by number of lymph nodes analysed), vascular invasion, and differentiation grade, each of these, however, typically revealed only during or after surgery [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Response and Elevated Tumour Markers Predict Worse Survival in Resectable Pancreatic Ductal Adenocarcinoma

et al. 2016

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BackgroundEstimation of the prognosis of resectable pancreatic ductal adenocarcinoma (PDAC) currently relies on tumour-related factors such as resection margins and on lymph-node ratio (LNR) both inconveniently available only postoperatively. Our aim was to assess the accuracy of preoperative laboratory data in predicting PDAC prognosis.MethodsCollection of laboratory and clinical data was retrospective from 265 consecutive patients undergoing surgery for PDAC at Helsinki University Hospital. Cancer-specific survival assessment utilized Kaplan-Meier analysis, and independent associations between factors were by the Cox regression model.ResultsDuring follow-up, 76% of the patients died of PDAC, with a median survival time of 19.6 months. In univariate analysis, CRP, albumin, CEA, and CA19-9 were significantly associated with postoperative cancer-specific survival. In multivariate analysis, taking into account age, gender, LNR, resection margins, tumour status, and adjuvant chemotherapy, the preoperative biomarkers independently associated with adverse prognosis were hypoalbuminemia (< 36 g/L, hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.10–2.19, p = 0.011), elevated CRP (> 5 mg/L, HR 1.44, 95% CI 1.03–2.02, p = 0.036), CEA (> 5 μg/L, HR 1.60, 95% CI 1.07–2.53, p = 0.047), and CA19-9 (≥555 kU/L, HR 1.91, 95% CI 1.18–3.08, p = 0.008).ConclusionFor patients with resectable PDAC, preoperative CRP, along with albumin and tumour markers, is useful for predicting prognosis.

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Section: Introductionmentioning

confidence: 99%

Systemic Inflammatory Response and Elevated Tumour Markers Predict Worse Survival in Resectable Pancreatic Ductal Adenocarcinoma

et al. 2016

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“…For a surgical oncologist, R0 resection may be the most important consideration. Certain studies have demonstrated that surgical margin affects survival (17)(18)(19), although this effect was not observed in other investigations (5,11,20,21). One study even proposed that repeated resection for margin clearance did not improve outcome (22).…”

Section: Discussionmentioning

confidence: 99%

Surgical Margin Status of Patients with Pancreatic Ductal Adenocarcinoma Undergoing Surgery with Radical Intent: Risk Factors for the Survival Impact of Positive Margins

Lai

Wang

Liao

et al. 2018

In Vivo

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Background: For pancreatic ductal adenocarcinoma (PDAC), surgical margin status is an important pathological factor for evaluating surgical adequacy. In this study, we attempted to investigate predictive factors for the survival impact of positive surgical margins. Materials and Methods: From February 2004 to December 2013, 204 patients were diagnosed with PDAC and underwent surgery with radical intent; 189 patients fulfilled our selection criteria and were enrolled for analysis. Results: For the 189 enrolled patients with PDAC, we found male predominance (112/189, 59%) and a median age of 64 years; most patients were diagnosed with stage IIB disease (n=115, 61%). The positive surgical margin rate was 21% (n=40). Carbohydrate antigen 19-9 (CA19-9) level higher than 246 U/ml (odds ratio (OR)=2.318; 95% confidence interval (CI)=1.037-5.181 p=0.040) and lesion location in the uncinate process (OR=2.996; 95% CI=1.232-7.284 p=0.015) were the only two independent risk factors for positive surgical margins. Positive retroperitoneal soft-tissue margins were the most frequently observed (24/40, 60%). Overall, positive surgical margins had no survival impact in the 189 patients with PDAC who underwent surgery; however, positive surgical margins had an unfavorable survival impact on patients with stage IIA PDAC who underwent surgery. Conclusion: Retroperitoneal soft-tissue was the most common site for positive surgical margins. Additionally, surgical margin positivity was more likely for tumors located in the uncinate process than for other tumors. Positive surgical margins had an unfavorable survival impact on patients with stage IIA PDAC who underwent surgery. Pancreatic ductal adenocarcinoma (PDAC) is a dismal condition with poor prognosis. The 5-year overall survival for PDAC may be as low as 1.3% (1). This poor outcome is attributable to advanced disease at diagnosis and inefficient treatment modalities. However, surgical resection remains the mainstream treatment for both primary tumor excision and precise staging for adjuvant treatment. Unfortunately, only 15-20% patients present with resectable disease at diagnosis (2, 3). For resectable PDAC, 5-year overall survival may be improved to up to 18% (4). For resectable PDAC, surgical margin status is an important pathological factor for evaluating surgical adequacy. However, the impact of this status on long-term clinical outcome remains debatable (5, 6). In this study, we attempted to investigate predictive factors for positive surgical margins after surgery with radical intent and the survival impact of surgical margin status. Materials and Methods From February 2004 to December 2013, 204 patients were diagnosed with PDAC and underwent surgery with radical intent. Eleven patients were excluded due to involvement of the superior mesentery artery or occult distant metastasis revealed after laparotomy. Four patients with surgical mortality (4/204, 1.96%, hospital mortality within 30 days after surgery) were also excluded. Therefore, 189 patients were enrolled for analysi...

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“…Yamamoto et al reported that T1 stage and R0 resection were prognostic factors after pancreatic resection 9 whereas Benassai and colleagues reported that tumor size 3 cm, R0 resection, and N0 status were independently associated with survival. 8 Completion of adjuvant chemotherapy has been identified as an independent prognostic factor after resection for PDAC. 21 In this retrospective study of patients undergoing pancreatic resection for cancer, we demonstrated that FE-1 200 mg/g, no lymph node metastasis and completion of adjuvant chemotherapy were independent prognostic factors for disease-free survival.…”

Section: Discussionmentioning

confidence: 99%

“…Histopathologic features such as tumor size, lymph node metastasis and surgical resection margin clearance are well known significant prognostic factors of recurrence. [6][7][8][9] Recently, several studies analyzed the relationship between tumor stroma and cancer progression in patients with PDAC and showed the prognostic role of tumor stroma with respect to patient prognosis. [10][11][12][13] Clinically, a high density of tumor stroma at the cellular level is considered fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Preoperative fecal elastase-1 is a useful prognostic marker following curative resection of pancreatic cancer

Lim

Park

Yoon

2017

HPB

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Long-term survival after curative resection for pancreatic ductal adenocarcinoma – Surgical treatment

Cited by 30 publications

References 30 publications

Systemic Inflammatory Response and Elevated Tumour Markers Predict Worse Survival in Resectable Pancreatic Ductal Adenocarcinoma

Systemic Inflammatory Response and Elevated Tumour Markers Predict Worse Survival in Resectable Pancreatic Ductal Adenocarcinoma

Surgical Margin Status of Patients with Pancreatic Ductal Adenocarcinoma Undergoing Surgery with Radical Intent: Risk Factors for the Survival Impact of Positive Margins

Preoperative fecal elastase-1 is a useful prognostic marker following curative resection of pancreatic cancer

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