TY - JOUR
T1 - Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma
AU - Katz, Matthew H.G.
AU - Wang, Huamin
AU - Fleming, Jason B.
AU - Sun, Charlotte C.
AU - Hwang, Rosa F.
AU - Wolff, Robert A.
AU - Varadhachary, Gauri
AU - Abbruzzese, James L.
AU - Crane, Christopher H.
AU - Krishnan, Sunil
AU - Vauthey, Jean Nicolas
AU - Abdalla, Eddie K.
AU - Lee, Jeffrey E.
AU - Pisters, Peter W.T.
AU - Evans, Douglas B.
N1 - Funding Information:
ACKNOWLEDGMENTS We thank Henry F. Gomez, MD, for database support, Karen R. Cleary, MD, for seminal contributions to the pathologic evaluation of surgical specimens, Chusilp Charnsan-gavej, MD, for support and leadership in diagnostic imaging, Jeffrey H. Lee, MD, for program development in interventional gastroenterology, Michael J. Wallace, MD, and his colleagues in interventional radiology for management of our surgical complications, and the many patients who have entrusted the University of Texas M. D. Anderson Cancer Center with their care. Supported by the Hamill Foundation, the Various Donor Fund for Pancreatic Cancer Research, and National Institutes of Health Grant CA101936-01 (SPORE in Pancreatic Cancer) at The University of Texas M. D. Anderson Cancer Center.
PY - 2009/4
Y1 - 2009/4
N2 - Introduction: Actual 5-year survival rates of 10-18% have been reported for patients with resected pancreatic adenocarcinoma (PC), but the use of multimodality therapy was uncommon in these series. We evaluated long-term survival and patterns of recurrence in patients treated for PC with contemporary staging and multimodality therapy. Methods: We analyzed 329 consecutive patients with PC evaluated between 1990 and 2002 who underwent resection. Each received a multidisciplinary evaluation and a standard operative approach. Pre- or postoperative chemotherapy and/or chemoradiation were routine. Surgical specimens of 5-year survivors were rereviewed. A multivariate model of factors associated with long-term survival was constructed. Results: Patients underwent pancreaticoduodenectomy (n = 302; 92%), distal (n = 20; 6%), or total pancreatectomy (n = 7; 2%). A total of 108 patients (33%) underwent vascular reconstruction, 301 patients (91%) received neoadjuvant or adjuvant therapy, 157 specimens (48%) were node positive, and margins were microscopically positive in 52 patients (16%). Median overall survival and disease-specific survival was 23.9 and 26.5 months. Eighty-eight patients (27%) survived a minimum of 5 years and had a median overall survival of 11 years. Of these, 21 (24%) experienced recurrence, 7 (8%) after 5 years. Late recurrences occurred most frequently in the lungs, the latest at 6.7 years. Multivariate analysis identified disease-negative lymph nodes (P = .02) and no prior attempt at resection (P = 0.01) as associated with 5-year survival. Conclusions: Our 27% actual 5-year survival rate for patients with resected PC is superior to that previously reported, and it is influenced by our emphasis on detailed staging and patient selection, a standardized operative approach, and routine use of multimodality therapy.
AB - Introduction: Actual 5-year survival rates of 10-18% have been reported for patients with resected pancreatic adenocarcinoma (PC), but the use of multimodality therapy was uncommon in these series. We evaluated long-term survival and patterns of recurrence in patients treated for PC with contemporary staging and multimodality therapy. Methods: We analyzed 329 consecutive patients with PC evaluated between 1990 and 2002 who underwent resection. Each received a multidisciplinary evaluation and a standard operative approach. Pre- or postoperative chemotherapy and/or chemoradiation were routine. Surgical specimens of 5-year survivors were rereviewed. A multivariate model of factors associated with long-term survival was constructed. Results: Patients underwent pancreaticoduodenectomy (n = 302; 92%), distal (n = 20; 6%), or total pancreatectomy (n = 7; 2%). A total of 108 patients (33%) underwent vascular reconstruction, 301 patients (91%) received neoadjuvant or adjuvant therapy, 157 specimens (48%) were node positive, and margins were microscopically positive in 52 patients (16%). Median overall survival and disease-specific survival was 23.9 and 26.5 months. Eighty-eight patients (27%) survived a minimum of 5 years and had a median overall survival of 11 years. Of these, 21 (24%) experienced recurrence, 7 (8%) after 5 years. Late recurrences occurred most frequently in the lungs, the latest at 6.7 years. Multivariate analysis identified disease-negative lymph nodes (P = .02) and no prior attempt at resection (P = 0.01) as associated with 5-year survival. Conclusions: Our 27% actual 5-year survival rate for patients with resected PC is superior to that previously reported, and it is influenced by our emphasis on detailed staging and patient selection, a standardized operative approach, and routine use of multimodality therapy.
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U2 - 10.1245/s10434-008-0295-2
DO - 10.1245/s10434-008-0295-2
M3 - Article
C2 - 19194760
AN - SCOPUS:62149143713
SN - 1068-9265
VL - 16
SP - 836
EP - 847
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 4
ER -