PMID- 11307091
OWN - NLM
STAT- MEDLINE
DCOM- 20010621
LR  - 20220331
IS  - 1091-255X (Print)
IS  - 1091-255X (Linking)
VI  - 4
IP  - 6
DP  - 2000 Nov-Dec
TI  - Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and 
      prognostic indicators.
PG  - 567-79
AB  - This large-volume, single-institution review examines factors influencing 
      long-term survival after resection in patients with adenocarcinoma of the head, 
      neck, uncinate process, body, or tail of the pancreas. Between January 1984 and 
      July 1999 inclusive, 616 patients with adenocarcinoma of the pancreas underwent 
      surgical resection. A retrospective analysis of a prospectively collected 
      database was performed. Both univariate and multivariate models were used to 
      determine the factors influencing survival. Of the 616 patients, 526 (85%) 
      underwent pancreaticoduodenectomy for adenocarcinoma of the head, neck, or 
      uncinate process of the pancreas, 52 (9%) underwent distal pancreatectomy for 
      adenocarcinoma of the body or tail, and 38 (6%) underwent total pancreatectomy 
      for adenocarcinoma extensively involving the gland. The mean age of the patients 
      was 64.3 years, with 54% being male and 91% being white. The overall 
      perioperative mortality rate was 2.3%, whereas the incidence of postoperative 
      complications was 30%. The median postoperative length of stay was 11 days. The 
      mean tumor diameter was 3.2 cm, with 72% of patients having positive lymph nodes, 
      30% having positive resection margins, and 36% having poorly differentiated 
      tumors. Patients undergoing distal pancreatectomy for left-sided lesions had 
      larger tumors (4.7 vs. 3.1 cm, P < 0.0001), but fewer node-positive resections 
      (59% vs. 73%, P = 0.03) and fewer poorly differentiated tumors (29% vs. 36%, P < 
      0.001), as compared to those undergoing pancreaticoduodenectomy for right-sided 
      lesions. The overall survival of the entire cohort was 63% at 1 year and 17% at 5 
      years, with a median survival of 17 months. For right-sided lesions the 1- and 
      5-year survival rates were 64% and 17%, respectively, compared to 50% and 15% for 
      left-sided lesions. Factors shown to have favorable independent prognostic 
      significance by multivariate analysis were negative resection margins (hazard 
      ratio [HR] = 0.64, confidence interval [CI] = 0.50 to 0.82, P = 0.0004), tumor 
      diameter less than 3 cm (HR = 0.72, CI = 0.57 to 0.90, P = 0.004), estimated 
      blood loss less than 750 ml (HR = 0.75, CI = 0.58 to 0.96, P = 0.02), 
      well/moderate tumor differentiation (HR = 0.71, CI = 0.56 to 0.90, P = 0.005), 
      and postoperative chemoradiation (HR = 0.50, CI = 0.39 to 0.64, P < 0.0001). 
      Tumor location in head, neck, or uncinate process approached significance in the 
      final multivariate model (HR = 0.60, CI = 0.35 to 1.0, P = 0.06). Pancreatic 
      resection remains the only hope for long-term survival in patients with 
      adenocarcinoma of the pancreas. Completeness of resection and tumor 
      characteristics including tumor size and degree of differentiation are important 
      independent prognostic indicators. Adjuvant chemoradiation is a strong predictor 
      of outcome and likely decreases the independent significance of tumor location 
      and nodal status.
FAU - Sohn, T A
AU  - Sohn TA
AD  - Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 
      21287-4606, USA.
FAU - Yeo, C J
AU  - Yeo CJ
FAU - Cameron, J L
AU  - Cameron JL
FAU - Koniaris, L
AU  - Koniaris L
FAU - Kaushal, S
AU  - Kaushal S
FAU - Abrams, R A
AU  - Abrams RA
FAU - Sauter, P K
AU  - Sauter PK
FAU - Coleman, J
AU  - Coleman J
FAU - Hruban, R H
AU  - Hruban RH
FAU - Lillemoe, K D
AU  - Lillemoe KD
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Gastrointest Surg
JT  - Journal of gastrointestinal surgery : official journal of the Society for Surgery 
      of the Alimentary Tract
JID - 9706084
SB  - IM
CIN - J Gastrointest Surg. 2001 Nov-Dec;5(6):681; author reply 681. PMID: 12086909
MH  - Adenocarcinoma/diagnosis/radiotherapy/*surgery
MH  - Aged
MH  - Analysis of Variance
MH  - Cohort Studies
MH  - Confidence Intervals
MH  - Female
MH  - Hospitals, University
MH  - Humans
MH  - Male
MH  - Maryland/epidemiology
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Pancreatectomy/*methods/mortality
MH  - Pancreatic Neoplasms/diagnosis/radiotherapy/*surgery
MH  - Pancreaticoduodenectomy/*methods/mortality
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Radiotherapy, Adjuvant
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2001/04/18 10:00
MHDA- 2001/06/22 10:01
CRDT- 2001/04/18 10:00
PHST- 2001/04/18 10:00 [pubmed]
PHST- 2001/06/22 10:01 [medline]
PHST- 2001/04/18 10:00 [entrez]
AID - S1091-255X(00)80105-5 [pii]
AID - 10.1016/s1091-255x(00)80105-5 [doi]
PST - ppublish
SO  - J Gastrointest Surg. 2000 Nov-Dec;4(6):567-79. doi: 
      10.1016/s1091-255x(00)80105-5.