Prognostic factors associated with early mortality after surgical resection for pancreatic adenocarcinoma

Abstract

Backgrounds/AimsIdentifying pancreatic cancer patients at high risk of early mortality following surgical resection for pancreatic cancer is important to make optimal treatment decisions in multidisciplinary setting. The purpose of this study was to identify the factors related to early mortality in patients who underwent pancreatic resection for pancreatic adenocarcinoma.MethodsWe reviewed our institution's experience with all consecutive patients who underwent pancreatectomy for pancreatic adenocarcinoma from January 2000 to December 2010. One thousand patients were eligible for our study. Fifty-three patients who did not meet the study criteria were excluded. Based on 12 months after surgery, patients were divided into early mortality group or the remaining group. We performed logistic regression analysis to identify predictors of early mortality.ResultsAmong 947 patients who met our study criteria, 302 (31.9%) early mortality (defined as experiencing death within 12 months after surgery) occurred. Multivariate analysis revealed that patient age and surgery time period were statistically significant predictors of early mortality within six months after surgery. Poorly differentiated tumor and adjuvant chemotherapy were statistically significant predictors of early mortality within 12 months after surgery. Total pancreatectomy and lymphovascular invasion were significant (p<0.05) prognostic factors of early mortality within 6 or 12 months after surgery.ConclusionsWe suggest followings to avoid early mortality after pancreatic resection: patients with multiple risk factors related to early mortality after pancreatectomy should be considered for alternative treatment; patient's general condition and surgical technique improvement are important; and adjuvant therapy should be taken into consideration.

Microscopic lymphovascular invasion is an independent predictor of survival in resected pancreatic ductal adenocarcinoma

“…Resected pancreatic ductal adenocarcinoma (PDA) continues to have a poor prognosis. Recently published series report 5‐year post‐resection survival rates between 6% and 24% . However, while PDA on average is one of the most aggressive cancers, a range in biologic phenotypes and patient survival exists.…”

“…survival rates between 6% and 24%. [1][2][3][4][5][6][7][8] However, while PDA on average is one of the most aggressive cancers, a range in biologic phenotypes and patient survival exists. For instance, the 1-year cancer-specific mortality following resection is roughly 20-27%, 9,10 yet 5-10% of patients survive beyond 10 years.…”

Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision‐making programme using decision tables

“…It is recommended to perform standardised surveillance 6 , 91 . The third systematic review identified 52 studies with 3570 patients who underwent total pancreatectomy with a pooled 30‐day mortality of 6% (95% confidence interval (CI) 4–8%) 16 , 30–80 . Of the four studies reporting on quality of life the mean global health status was 75% (on a scale of 0–100%) based on the EORTC QLQ‐C30 questionnaire (102 patients) and moderately lower compared with the general population 32 , 35 , 48 , 61 .…”

“…Studies addressing the outcomes of total pancreatectomy. All studies reporting on total pancreatectomy outcome were included 16 , 30–80 …”

Predicting Abdominal Surgery Mortality: A Model Based on Intra-abdominal Pressure

“…Several factors are involved in post-MAS clinical course whose relationship to mortality justifi es their inclusion in scoring systems: age, malignancy (as a cause or comorbidity), acute impairment of vital physiological variables, failure to control focus of infection, and nutritional status, [7,[14][15][16][17][18][19][20][21][22] Elevated intra-abdominal pressure (IAP) is an independent factor related to complications and death after MAS. [23][24][25][26][27][28][29][30][31][32] The fact that its measurement does not require major resources suggests it would be particularly useful in lowresource settings, but to date there have been no reports of its inclusion in predictive indices of mortality after MAS.…”