Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas

Background and Objectives: Recent reports have demonstrated improvement in the 5-year actuarial survival for patients with resected ductal adenocarcin oma. The purpose of this study is to determine the factors favoring long-te rm survival after pancreaticoduodenectomy. Methods: Between 1974 and 1995, 75 patients with pancreatic head carcinoma underwent pancreaticoduodenectomy in our department. Results: Overall postoperative mortality rate was 5.3% and morbidity was 24 %. Median survival following resection was 17 months. Estimated 1-, 2-, and 5-year survival rates were 68%, 46.7%, and 18.7%, respectively. Five-year survival was greater for node-negative than for node-positive patients (41. 7% vs. 7.8%, P < 0.001) and for smaller (<3 cm) than for larger tumors (33. 3% vs. 8.8%, P < 0.006). The 5-year survival in patients with negative marg ins (n = 60) was 23.3%, whereas no patient with positive margins (n = 15) s urvived at 13 months (P < 0.001). Multivariate analysis, performed by the C ox proportional hazards model, indicated that margin status, lymph node met astasis, tumor size, and poor histological differentiation were independent predictors of poor survival. Conclusions: Five-year survival for patients undergoing pancreaticoduodenec tomy for ductal adenocarcinoma of the pancreas was 18.7%. Survival was grea ter in the group of patients with negative lymph nodes, tumor size <3 cm, a nd negative margin status. (C) 2000 Wiley-Liss, Inc.