Predictors of Survival Following Resection for Ductal Adenocarcinoma of the Head of Pancreas: a Single-Institution Experience

Abstract

© The Author 2013.Background: Pancreatic adenocarcinoma is considered to be one of the most fatal human malignancies, Complete surgical resection is the only treatment that can offer hope for prolonged survival. However, even after a curative resection, the overall 5-year survival rate is only 10% to 29%. This bad prognosis is principally due to late diagnosis at an advanced stage: 85% of tumors are unresectable for cure at the initial staging assessment due to liver metastases, peritoneal seeding (50%), or loco-regional extension (locally advanced tumor with vascular invasion, or remote nodal spread) (35%).In the current study, we aimed to examine the clinico-pathological predicting factors for the 5-year survival following radical resection of pancreatic head ductal adenocarcinoma. Methods:We retrospectively reviewed the medical files of forty-one patients with ductal adenocarcinoma of the head of pancreas, who had undergone pancreaticoduodenectomy at South Egypt Cancer Institute (SECI), Assiut University, in the period from 2005 to 2010. STATAversion 12 was used for data analysis. Univariate analysis for the most important factors regarding patients, tumor and operation carried out using chi-square and t-test analysis.We have conducted survival analysis via Cox proportional hazard regression model to investigate the prognostic factors after tumor resection. Results: The mean age for the study cohort was 55.3 ± 9.6 years and 56.1% were males. The follow up time ranged from 0.6 to 36 months with a median of 14 months. The results of the univariate analysis revealed that weight loss, hemoglobin level, serum albumin level, pre-operative blood transfusion, WHO performance scale, co-morbidity, intra-operative blood transfusion, tumor size, tumor type, tumor stage, hospital re-admission, pulmonary complication, biliary fistula, delay gastric empty, disease free status, post-operative chemotherapy, pre-operative plasma infusion, pre-operative salt-free albumin infusion, post-operative plasma infusion and post-operative blood transfusion were associated with the patients survival. The major predictors for better survival for patients included in this study were hemoglobin level more than 10mg/dl, serum albumin more than 30 mg/dl, tumor size less than 3 cm, early stage cancer, absence of co-morbidity and administration of post-operative chemotherapy. Conclusion: Early stage and small size pancreatic head ductal adenocarcinoma, in patients with good nutritional status without associated comorbidities, results in long-term survival after resection with adjuvant chemotherapy.