PANCREATICODUODENECTOMY FOR CANCER OF THE HEAD OF THE PANCREAS - 201 PATIENTS

Objective This single-institution study examined the outcome after pan creaticoduodenectomy in patients with adenocarcinoma of the head of th e pancreas. Summary of Background Data In recent years, pancreaticoduo denectomy for adenocarcinoma of the head of the pancreas has been asso ciated with decreased morbidity and mortality and, in some centers, 5- year survival rates in excess of 20%. Methods Two hundred one patients with pathologically verified adenocarcinoma of the head of the pancre as undergoing pancreaticoduodenectomy at The Johns Hopkins Hospital be tween 1970 and 1994 were analyzed (the last 100 resections were perfor med between March 1991 and April 1994). This is the largest single-ins titution experience reported to date. Results The overall postoperativ e in-hospital mortality rate was 5%, but has been 0.7% for the last 14 9 patients. The actuarial 5-year survival for all 201 patients was 21% , with a median survival of 15.5 months. There were 11 5-year survivor s. Patients resected with negative margins (curative resections: n = 1 43) had an actuarial 5-year survival rate of 26%, with a median surviv al of 18 months, whereas those with positive margins (palliative resec tions: n = 58) fared significantly worse, with an actuarial 5-year sur vival rate of 8% and a median survival of 10 months (p < 0.0001). Surv ival has improved significantly from decade to decade p < 0.002), with the 5-year actuarial survival of 14% in the 1970s, 21% in the 1980s, and 36% in the 1990s. Factors significantly favoring long-term surviva l by univariate analyses included tumor diameter < 3 cm, negative noda l status, diploid tumor DNA content, tumor S phase fraction < 18%, pyl orus preserving resection, < 800 mt intraoperative blood loss, < 2 uni ts of blood transfused, negative resection margins, and use of postope rative adjuvant chemotherapy and radiation therapy. Multivariate analy ses indicated the strongest predictors of long-term survival were dipl oid tumor DNA content, tumor diameter < 3 cm, negative nodal status, n egative resection margins, and decade of resection. Conclusions The su rvival of patients with pancreatic adenocarcinoma treated by pancreati coduodenectomy is improving. Aspects of tumor biology, such as DNA con tent, tumor diameter, nodal status and margin status, are the stronges t predictors of outcome.