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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2015

01-04-2015 | Pancreatic Tumors

Improved Long-Term Outcomes After Resection of Pancreatic Adenocarcinoma: A Comparison Between Two Time Periods

Authors: Pablo E. Serrano, MD, MPH, MSc, Sean P. Cleary, MD, MPH, MSc, Neesha Dhani, MD, Peter T. W. Kim, MD, Paul D. Greig, MD, Kenneth Leung, MD, Carol-Anne Moulton, MD, PhD, Steven Gallinger, MD, MSc, Alice C. Wei, MD, CM, MSc

Published in: Annals of Surgical Oncology | Issue 4/2015

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Abstract

Background

Despite reduced perioperative mortality and routine use of adjuvant therapy following pancreatectomy for pancreatic ductal adenocarcinoma (PDAC), improvement in long-term outcome has been difficult to ascertain. This study compares outcomes in patients undergoing resection for PDAC within a single, high-volume academic institution over two sequential time periods.

Methods

Retrospective review of patients with resected PDAC, in two cohorts: period 1 (P1), 1991–2000; and period 2 (P2), 2001–2010. Univariate and multivariate analyses using the Cox proportional hazards model were performed to determine prognostic factors associated with long-term survival. Survival was evaluated using Kaplan–Meier analyses.

Results

A total of 179 pancreatectomies were performed during P1 and 310 during P2. Perioperative mortality was 6.7 % (12/179) in P1 and 1.6 % (5/310) in P2 (p = 0.003). P2 had a greater number of lymph nodes resected (17 [0–50] vs. 7 [0–31]; p < 0.001), and a higher lymph node positivity rate (69 % [215/310] vs. 58 % [104/179]; p = 0.021) compared with P1. The adjuvant therapy rate was 30 % (53/179) in P1 and 63 % (195/310) in P2 (p < 0.001). By multivariate analysis, node and margin status, tumor grade, adjuvant therapy, and time period of resection were independently associated with overall survival (OS) for both time periods. Median OS was 16 months (95 % confidence interval [CI] 14–20) in P1 and 27 months (95 % CI 24–30) in P2 (p < 0.001).

Conclusions

Factors associated with improved long-term survival remain comparable over time. Short- and long-term survival for patients with resected PDAC has improved over time due to decreased perioperative mortality and increased use of adjuvant therapy, although the proportion of 5-year survivors remains small.
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Metadata
Title
Improved Long-Term Outcomes After Resection of Pancreatic Adenocarcinoma: A Comparison Between Two Time Periods
Authors
Pablo E. Serrano, MD, MPH, MSc
Sean P. Cleary, MD, MPH, MSc
Neesha Dhani, MD
Peter T. W. Kim, MD
Paul D. Greig, MD
Kenneth Leung, MD
Carol-Anne Moulton, MD, PhD
Steven Gallinger, MD, MSc
Alice C. Wei, MD, CM, MSc
Publication date
01-04-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 4/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4196-2

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