A Margin-Negative R0 Resection Accomplished With Minimal Postoperative Complications Is the Surgeon's Contribution to Long-Term Survival in Pancreatic Cancer

Thomas J. Howard, Joseph E. Krug, Jian Yu, Nick J. Zyromski, C.  Max Schmidt, Lewis E. Jacobson, James A. Madura, Eric A A. Wiebke, Keith D. Lillemoe

Research output: Contribution to journalArticle

229 Citations (Scopus)

Abstract

Pancreatic cancer has a poor prognosis with complete surgical resection being the only therapy to offer a realistic chance for long-term survival. The aim of this study is to identify surgery-related variables that influence long-term survival. Between 1990 and 2002, 226 consecutive patients (mean age of 64 ± 11 years) had resection for pancreatic adenocarcinoma. Prognostic variables in these patients were analyzed using univariate and multivariate analysis. Two hundred four patients (90%) had pancreaticoduodenectomy, 13 patients (6%) had distal pancreatectomy, and 9 patients (4%) had a TP. Stage I disease was present in 50 (22%), stage II disease in 170 (75%), and stage III disease in 6 (3%). R0 resections were achieved in 70%. Operative morbidity was 36% and 30-day mortality was 6%. Actual 1-year, 3-year, and 5-year survival rates were 49% (n = 111), 14% (n = 31), and 4% (n = 9). Using multivariate analysis: tumor size, tumor differentiation, obtaining an R0 resection, and lack of postoperative complications were variables associated with long-term survival. Long-term survival in patients with pancreatic cancer after resection remains poor. Achieving a margin negative resection (R0) with no postoperative complications are prognostic variables that can be affected by the surgeon.

Original languageEnglish (US)
Pages (from-to)1338-1346
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume10
Issue number10
DOIs
StatePublished - Dec 1 2006

Fingerprint

Pancreatic Neoplasms
Survival
Multivariate Analysis
Pancreatectomy
Pancreaticoduodenectomy
Surgeons
Neoplasms
Adenocarcinoma
Survival Rate
Morbidity
Mortality

Keywords

  • distal pancreatectomy
  • long-term survival
  • Pancreatic adenocarcinoma
  • pancreaticoduodenectomy
  • postoperative complications
  • R0 resection
  • total pancreatectomy

ASJC Scopus subject areas

  • Surgery

Cite this

A Margin-Negative R0 Resection Accomplished With Minimal Postoperative Complications Is the Surgeon's Contribution to Long-Term Survival in Pancreatic Cancer. / Howard, Thomas J.; Krug, Joseph E.; Yu, Jian; Zyromski, Nick J.; Schmidt, C.  Max; Jacobson, Lewis E.; Madura, James A.; Wiebke, Eric A A.; Lillemoe, Keith D.

In: Journal of Gastrointestinal Surgery, Vol. 10, No. 10, 01.12.2006, p. 1338-1346.

Research output: Contribution to journalArticle

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abstract = "Pancreatic cancer has a poor prognosis with complete surgical resection being the only therapy to offer a realistic chance for long-term survival. The aim of this study is to identify surgery-related variables that influence long-term survival. Between 1990 and 2002, 226 consecutive patients (mean age of 64 ± 11 years) had resection for pancreatic adenocarcinoma. Prognostic variables in these patients were analyzed using univariate and multivariate analysis. Two hundred four patients (90{\%}) had pancreaticoduodenectomy, 13 patients (6{\%}) had distal pancreatectomy, and 9 patients (4{\%}) had a TP. Stage I disease was present in 50 (22{\%}), stage II disease in 170 (75{\%}), and stage III disease in 6 (3{\%}). R0 resections were achieved in 70{\%}. Operative morbidity was 36{\%} and 30-day mortality was 6{\%}. Actual 1-year, 3-year, and 5-year survival rates were 49{\%} (n = 111), 14{\%} (n = 31), and 4{\%} (n = 9). Using multivariate analysis: tumor size, tumor differentiation, obtaining an R0 resection, and lack of postoperative complications were variables associated with long-term survival. Long-term survival in patients with pancreatic cancer after resection remains poor. Achieving a margin negative resection (R0) with no postoperative complications are prognostic variables that can be affected by the surgeon.",
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