Long-term survival after resections for pancreatic ductal adenocarcinoma. Single centre study

Abstract

Aim. To analyse the 5-year survival rate of patients undergoing radical surgery for pancreatic ductal adenocarcinoma (PDAC) and to identify prognostic factors. Methods. A prospectively maintained database of 90 consecutive patients who underwent radical resection for PDAC was analysed. Survival was evaluated using the Kaplan-Meier method. Log-rank test and Cox regression analysis were used for the evaluation of prognostic factors. P values less than 0.05 were considered significant. Results. Mean age (± standard deviation) was 63.2±8.6 years (female 28.9% and male 71.1%). Tumour localisation was in the head in 76 (84.5%), multifocal in 3 (3.3%) and in the body/tail in 11 (12.2%). Pancreatic head resection was performed in 75 (83.3%), total pancreatectomy in 4 (4.4%) and distal pancreatectomy with splenectomy in 11 (12.2%), with standard lymphadenectomy. Venous resection was in 4 (4.4%). Thirty-day and in-hospital mortality occurred in 1 (1.1%), 90-day mortality was 3.3%. On univariate analysis absence of perineural and vascular invasion, stage, absence of lymph node infiltration and no need for transfusion were associated with improved overall survival. On multivariate analysis vascular invasion HR=3.137 (95%CI: 1.692-5.816; P = 0.0003) and postoperative complications HR=2. ; P = 0.008) were identified as significant independent predictors of survival. The five-year survival rate was 18.9%, with five-year recurrence-free survival of 16.7%. Conclusion. Vascular invasion and postoperative complications were independent prognostic factors after curative resections of pancreatic cancer in studied cohort.

Genetic analysis of subsequent second primary malignant neoplasms in long-term pancreatic cancer survivors suggests new potential hereditary genetic alterations

“…The principal objective of this study was the identification of SMNs in this cohort of patients. The criteria used for the definition of SMN were derived from Waren and Gates, including a histologic confirmation of the second primary malignancy, anatomical separations of both tumors or recurrence exclusion, and a second tumor diagnosis >6 months after the diagnosis of the first tumor 2. The SMNs in the studied cohort were diagnosed by physical examination, endoscopy, and/or diagnostic imaging (CT/PET-CT) and were histologically verified.…”

“…SMNs are a major cause of mortality and serious morbidity among cancer survivors who have been successfully cured of their first cancer. Their etiologies are multiple and may relate to the role of primary cancer treatment (mainly radiotherapy and chemotherapy), unhealthy lifestyle behaviors, germline and somatic mutations, aging, and most likely a combination of any of these factors 2,3. Because of the unfavorable prognosis, very few long-term PDAC survivors will develop SMN 2,3.…”

“…Their etiologies are multiple and may relate to the role of primary cancer treatment (mainly radiotherapy and chemotherapy), unhealthy lifestyle behaviors, germline and somatic mutations, aging, and most likely a combination of any of these factors 2,3. Because of the unfavorable prognosis, very few long-term PDAC survivors will develop SMN 2,3. Consequently, there are very few reports about SMNs in PDAC survivors and their prognosis, and there is no information on the genetic background of these patients 2–9…”

“…Because of the unfavorable prognosis, very few long-term PDAC survivors will develop SMN 2,3. Consequently, there are very few reports about SMNs in PDAC survivors and their prognosis, and there is no information on the genetic background of these patients 2–9…”

Different clinical presentations of metachronous pulmonary metastases after resection of pancreatic ductal adenocarcinoma: Retrospective study and review of the literature

“…The prognosis of PDAC patients after curative surgery is still relatively poor with the 5-year survival rate ranging between 15%-35%[ 5 - 7 ]. Up to 30% of PDAC patients die within the first year after radical surgery due to the disease progression and the mortality rate increases to around 60% by the end of the second year[ 8 , 9 ].…”