Predicting survival after surgical resection for pancreatic ductal adenocarcinoma

Objectives: We reviewed the pancreatectomies that were done for pancreatic ductal adenocarcinoma to evaluate patient survival and prognostic predictors. Methods: A review was performed on 94 patients who underwent surgical resection for pancreatic ductal adenocarcinomas from 1995 to 2002. The perioperative factors were compared between the proximal and distal lesions by the chi(2) test and t test. Possible predictors for survival were examined for by univariate and multivariate analysis. Results: The 5-year survival was 16%. The proximal lesions had a smaller tumor size (3.0 +/- 0.11 vs. 3.9 +/- 0.33 cm, respectively; P = 0.03), a higher incidence of nodal involvement (60.6% vs. 34.8%, respectively; P = 0.031), and poorer histologic differentiation (25.4% vs. 13.0%, respectively; P = 0.01) compared with the distal lesions, and both types of lesions had similar rates of intraoperative transfusion, complete resection, and survival. The factors shown to have favorable independent prognostic significance were negative resection margins ( hazard ratio [HR] = 0.23; 95% confidence interval [CI] = 0.12 - 0.42; P< 0.001), a tumor diameter less than 3 cm ( HR = 0.46; 95% CI = 0.27 - 0.78; P = 0.004), well/moderate tumor differentiation ( HR = 0.37; 95% CI = 0.19 - 0.72; P = 0.004), and adjuvant therapy ( HR = 0.61; 95% CI = 0.37 - 0.99; P = 0.49). Conclusions: For the long-term survival of patients with pancreatic ductal adenocarcinoma, complete excision is the most important therapeutic option, and adjuvant therapy is a significant contributing factor.