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The role of surgery for pancreatic cancer: a 12-year review of patient outcome.

Badger SA, Brant JL, Jones C, McClements J, Loughrey MB, Taylor MA, Diamond T, McKie LD - Ulster Med J (2010)

Bottom Line: Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001).Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality.Tumour differentiation and nodal status are important predictors of outcome.

View Article: PubMed Central - PubMed

Affiliation: Hepatobiliary Surgical Unit, Mater Hospital, Belfast Health and Social Care Trust, Crumlin Road, Belfast BT14 6AB. stephenbadger@btinternet.com

ABSTRACT

Introduction: Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival.

Patients and methods: All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test.

Results: 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenocarcinoma compared to all other pathologies (p=0.013), while periampullary tumours had a better prognosis compared to other locations (p=0.019). Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001). Survival was worse with perineural (p=0.04) or lymphovascular invasion (p=0.05). A microscopic postive resection margin (R1) was associated with a worse survival (p=0.007). Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality.

Conclusion: Tumour differentiation and nodal status are important predictors of outcome. A positive resection margin is associated with a poorer survival.

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Related in: MedlinePlus

Normal peri-pancreatic anatomy
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fig1: Normal peri-pancreatic anatomy

Mentions: The head of the pancreas lies within the duodenal curve, with the upper, lower and right lateral borders lying intimately to the duodenum (Figure 1). The ascending portion of the duodenum lies in front of the left lateral border of the head. The anterior aspect is largely covered by the transverse colon, with the superior mesenteric artery crossing the uncinate process. The corresponding vein travels up behind the neck to form the portal vein. Posterior to the head of pancreas lies the inferior vena cava, the common bile duct, the renal veins, the aorta and right crus of the diaphragm.


The role of surgery for pancreatic cancer: a 12-year review of patient outcome.

Badger SA, Brant JL, Jones C, McClements J, Loughrey MB, Taylor MA, Diamond T, McKie LD - Ulster Med J (2010)

Normal peri-pancreatic anatomy
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2993146&req=5

fig1: Normal peri-pancreatic anatomy
Mentions: The head of the pancreas lies within the duodenal curve, with the upper, lower and right lateral borders lying intimately to the duodenum (Figure 1). The ascending portion of the duodenum lies in front of the left lateral border of the head. The anterior aspect is largely covered by the transverse colon, with the superior mesenteric artery crossing the uncinate process. The corresponding vein travels up behind the neck to form the portal vein. Posterior to the head of pancreas lies the inferior vena cava, the common bile duct, the renal veins, the aorta and right crus of the diaphragm.

Bottom Line: Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001).Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality.Tumour differentiation and nodal status are important predictors of outcome.

View Article: PubMed Central - PubMed

Affiliation: Hepatobiliary Surgical Unit, Mater Hospital, Belfast Health and Social Care Trust, Crumlin Road, Belfast BT14 6AB. stephenbadger@btinternet.com

ABSTRACT

Introduction: Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival.

Patients and methods: All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test.

Results: 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenocarcinoma compared to all other pathologies (p=0.013), while periampullary tumours had a better prognosis compared to other locations (p=0.019). Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001). Survival was worse with perineural (p=0.04) or lymphovascular invasion (p=0.05). A microscopic postive resection margin (R1) was associated with a worse survival (p=0.007). Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality.

Conclusion: Tumour differentiation and nodal status are important predictors of outcome. A positive resection margin is associated with a poorer survival.

Show MeSH
Related in: MedlinePlus