Risk factors influencing recurrence following resection of pancreatic head cancer

AIM:Whether operative procedure is a risk factor influencing recurrence following resection of carcinoma in the head of pancreas or not remains controversies. In this text we compared the recurrence rate of two operative procedure:the Whipple procedure and extended radical operation, and inquired into the factors influencing recurrence after radical resection.METHODS: From January 1995 to December 1998, 35 cases of carcinoma of pancreas underwent the Whipple operadure,21 patients received the Extended radical operation.All patients were followed up for more than 3 years.Prognostic factors included operative procedure, size of tumor, lymph node, interstitial invasion.RESULTS: Deaths duo to recurrence within 3 years after operation were studied.The death rate was 51.4% in the Whipple procedure and 42.9% in the Extended radical operative procedure.There was a significant difference between the two groups. Recurrence occurred in 75% patients with tumor large than 4cm, in 87.5% patients with lymph node involvement, and in 50% patients with the presence of interstitial invasion.CONCLUSION:Tumor exceeding 4 cm,lymph node involvement,and presence of interstitial invasion are high risk factors of recurrence after Whipple‘s procedure and extended radical operation.     

Long-term survival after surgical resection for pancreatic cancer

BACKGROUND/AIMS: Pancreatic cancer remains one of the most formidable tumors defying early detection and effective treatment. Long-term survivors, however, do exist after resection. We investigated the clinicopathologic features of patients with pancreatic cancer who survived more than 5 years to draw out some suggestions concerning the indication of surgical treatment. METHODOLOGY: We studied the clinicopathologic features of 13 patients with pancreatic cancer who survived more than 5 years after resection. We reviewed their clinical records to investigate preoperative symptoms, serum tumor markers, operative findings, postoperative adjuvant therapy, and modes of recurrence and survival periods. Information on the location, size, histology and spread of the primary tumors were mainly obtained from pathology reports. RESULTS: Histologic types of the long survivors included ductal adenocarcinoma of common type in 4 patients, mucinous noncystic adenocarcinoma in 2, intraductal papillary-mucinous carcinoma (invasive) in 4, undifferentiated carcinoma in 1, endocrine tumor (islet cell carcinoma) in 1 and acinar cell carcinoma in 1. All 4 cases of ductal adenocarcinoma of the common type showed a moderate invasion either to the retroperitoneum, the portal vein or the duodenum. Two patients with mucinous noncystic carcinoma attained a long survival despite extensive invasion of the pancreatic stroma, although one died of peritoneal carcinomatosis. Two of 4 patients with intraductal papillary-mucinous cancer (invasive) died of peritoneal dissemination 6 and 11 years after resection, respectively. Three patients with cancer of other special histologic types, i.e., undifferentiated, well-differentiated endocrine carcinoma and acinar cell carcinoma, showed invasion of the portal vein and splenic artery, involvement of the retroperitoneum and a metastatic tumor in the liver, respectively. CONCLUSIONS: Whereas special histologic types including ductal variants tended to predispose to long-term survival, ductal adenocarcinoma of the common type had some chance of long survival even with invasion of the surrounding tissues.     

Long-term survival after resection of pancreatic cancer:A single-center retrospective analysis

AIM: To retrospectively analyze factors affecting the long-term survival of patients with pancreatic cancer who underwent pancreatic resection.METHODS: From January 2000 to December 2011,195 patients underwent pancreatic resection in our hospital.The prognostic factors after pancreatic resection were analyzed in all 195 patients.After excluding the censored cases within an observational period,the clinicopathological characteristics of 20 patients who survived ≥ 5(n = 20) and 5(n = 76) years were compared.For this comparison,we analyzed the patients who underwent surgery before June 2008 and were observed for more than 5 years.For statistical analyses,the log-rank test was used to compare the cumulative survival rates,and the χ2 and Mann-Whitney tests were used to compare the two groups.The CoxHazard model was used for a multivariate analysis,and P values less than 0.05 were considered significant.A multivariate analysis was conducted on the factors that were significant in the univariate analysis.RESULTS: The median survival for all patients was 27.1 months,and the 5-year actuarial survival rate was 34.5%.The median observational period was 595 d.With the univariate analysis,the UICC stage was significantly associated with survival time,and the CA19-9 ≤ 200 U/m L,DUPAN-2 ≤ 180 U/m L,t u m o r s i ze ≤ 2 0 m m,R 0 re s e c t i o n,a b s e n c e o f lymph node metastasis,absence of extrapancreatic neural invasion,and absence of portal invasion were favorable prognostic factors.The multivariate analysis showed that tumor size ≤ 20 mm(HR = 0.40; 95%CI: 0.17-0.83,P = 0.012) and negative surgical margins(R0 resection)(HR = 0.48; 95%CI: 0.30-0.77,P = 0.003) were independent favorable prognostic factors.Among the 96 patients,20 patients survived for 5 years or more,and 76 patients died within 5 years after operation.Comparison of the 20 5-year survivors with the 76 non-survivors showed that lower concentrations of DUPAN-2(79.5 vs 312.5 U/mL,P = 0.032),tumor size ≤ 20 mm(35% vs 8%,P = 0.008),R0 resection(95% vs 61%,P = 0.004),and absence of lymph nodemetastases(60% vs 18%,P = 0.036) were significantly associated with the 5-year survival.CONCLUSION: Negative surgical margins and a tumor size ≤ 20 mm were independent favorable prognostic factors.Histologically curative resection and early tumor detection are important factors in achieving long-term survival.     

Risk factors of long-term survival and recurrence after curative resection of hepatocellular carcinoma

BACKGROUND/AIMS: The independent risk factors contributing to long-term survival (> or = 10-year survival rate) and recurrence after curative hepatic resection for hepatocellular carcinoma (HCC) were evaluated. METHODOLOGY: The prognoses were retrospectively analyzed in 247 consecutive patients (187 men and 60 women) treated with curative hepatic resection for HCC and discharged from the hospital. Prognostic factors were evaluated by multivariate analysis using Cox's proportional hazards model. RESULTS: Multivariate analysis revealed that pTNM stage IV, indocyanine green retention rate at 15 minutes (ICGR15) of > or = 20%, tumor size of > or = 5 cm, and positive hepatitis B surface antigen were independent risk factors of overall survival. Stage IV and ICGR15 of > or = 20% were also independent risk factors of disease-free survival. CONCLUSIONS: pTNM stage and ICGR15 may be simple and useful predictors to improve long-term survival and recurrence after curative hepatic resection for HCC.     

Treatment of locoregional recurrence after intentional curative resection of pancreatic cancer.

In order to analyze the results of treatment of patients with locoregional recurrence after intentional curative resection of pancreatic cancer, a retrospective study was performed. During the period 1978-1988, 108 patients underwent an intentional curative resection fo the pancreas. In 34 patients locoregional recurrence occurred, all within a period of three years (cumulative recurrence rate 56%). Sixty-eight percent of the patients presented with upper abdominal pain, and 62% with weight loss. Survival was significantly better (p = 0.02) in the group of 18 patients without distant metastases (1-year survival 22%) than in the 16 patients with distant metastases (1-year survival 0%). Five patients without proven distant metastases were treated by resection or chemotherapy. The mean survival was 33 months (range 6-74) in the treated group, and 4 months (0.4-7 months) in the untreated group, p = 0.002. In this retrospective study the longest survival was seen after radical resection of locoregional tumor recurrence. We therefore recommend that patients with locoregional recurrence without distant metastases after intentional curative resection of pancreatic cancer be treated.     

Rectal cancer: factors influencing the development of local recurrence after radical anterior resection

The study was designed to select criteria which influence the incidence of local recurrence after radical anterior resection for rectal cancer. Local recurrence developed in 18 patients (20%) out of 90. All patients entered a prospective clinical study for the detection of local recurrence (mean observation time: 50 months). The following criteria were evaluated retrospectively: age, sex, staging, grading, gross appearance of the tumour, lymphatic reaction, invasion of lymph- and blood vessels, perineural invasion, mucus production of the tumour and width of the distal margin of clearance (measurement in cm in the specimen immediately after resection). The incidence of local recurrence (%) depended on Dukes stage (A: 7%, B: 17%, C: 40%;p0.03), grading (well differentiated: 5%, average: 20%, poorly differentiated: 55%;p0.02), gross appearance (protuberant: 15%, infiltrating: 47%;p0.006), lymphatic stroma reaction (yes: 10%, no: 45%;p0.006), invasion of veins (yes: 75%, no: 20%;p0.0002), perineural invasion (yes: 52%, no: 17%;p0.001) and the margin of clearance (<1 cm: 52%; 1–3 cm: 10%, > 3 cm: 15%;p0.02 Mantel,p0.05 Breslow between <1 cm vs 1–3 cm and >3 cm, respectively). Local recurrence was not related to age, sex and mucus production of the tumour. Unfavourable morphological criteria may help to define groups with a higher risk of developing local recurrence. A tumour-free margin exceeding at least 1 cm appears necessary to reduce the rate of local recurrence. Dr. Wolfgang Feil     

Novel postoperative adjuvant strategy prevents early hepatic recurrence after resection of pancreatic cancer

Background/Purpose

It has been reported recently that adjuvant gemcitabine prolonged postoperative disease-free survival in patients with resectable pancreatic cancer. However, the efficacy was limited and further studies are required to improve the prognosis. In particular, postoperative hepatic recurrence often occurs even after gemcitabine treatment.

Methods

We are currently trying to evaluate the efficacy of postoperative combination therapy of high-dose 5-fluorouracil (5-FU) arterial infusion with systemic gemcitabine. Patients received weekly high-dose 5-FU through the hepatic artery using a port-catheter system (1000?mg/m² for 5?h) plus concurrent systemic gemcitabine (1000?mg/m²).

Results

Thirty-one patients were enrolled and 29 patients (94%) completed the scheduled adjuvant chemotherapy. The toxicity was acceptable and this regimen was well feasible as an outpatient treatment. At the time of analysis, 21 patients (68%) had recurrence. Local recurrence was most frequently observed, in 43% of the patients with recurrence. On the other hand, hepatic recurrence developed in only 2 patients (10%). The 1-year disease-free rate and overall survival rate were 62.9 and 100%, respectively.

Conclusion

Our novel adjuvant strategy had a significant beneficial effect on early hepatic recurrence and may have the potential to prolong the overall survival of pancreatic cancer patients.     

Multi-institutional analysis of pancreatic adenocarcinoma demonstrating the effect of diabetes status on survival after resection

BackgroundThe effect of diabetes on survival after resection pancreatic ductal carcinoma (PDAC) is unclear. The present study was undertaken to determine whether pre-operative diabetes has any predictive value for survival.MethodsA retrospective review from seven centres was performed. Metabolic factors, tumour characteristics and outcomes of patients undergoing resection for PDAC were collected. Univariate and multivariable analyses were performed to determine factors associated with disease-free (DFS) and overall survival (OS).ResultsOf the 509 patients in the present study, 31.2% had diabetes. Scoring systems were devised to predict OS and DFS based on a training set (n= 245) and were subsequently tested on an independent set (n= 264). Pre-operative diabetes (P < 0.001), tumour size >2 cm (P= 0.001), metastatic nodal ratio >0.1 (P < 0.001) and R1 margin (P < 0.001) all correlated with DFS and OS on univariate analysis. Scoring systems were devised based on multivariable analysis of the above factors. Diabetes and the metastatic nodal ratio were the most important factors in each system, earning two points for OS and four points for DFS. These scoring systems significantly correlated with both DFS (P < 0.001) and OS (P < 0.001).ConclusionPre-operative diabetes status provides useful information that can help to stratify patients in terms of predicted post-operative OS and DFS.     

Long-term survival after multimodality treatment for resectable pancreatic cancer

Summary Background. The prognosis of pancreatic adenocarcinoma after radical pancreatectomy is poor, especially in advanced-stage disease. Study Aim. To determine the survival rates and evaluate the effectiveness of multimodality treatment for advanced pancreatic cancer. Methods. From November 1983 to January 1993, 30 patients with pancreatic adenocarcinoma including 9 with carcinoma of the body and tail were treated by a multimodal approach consisting of extended pancreatectomy, intraoperative radiotherapy (IORT), and hepatic artery or portal vein infusion of mitomycin C (MMC) followed by systemic bolus injection. All surviving patients were followed for more than 8 yr and survival rates were calculated by the Kaplan-Meier method. Results. There were no operative or hospital deaths. Eight patients survived for more than 5 yr, 3 of whom survived more than 10 yr. The 5-yr survival rate for 27 patients excluding 3 with metastasis to the liver, peritoneum, or lung was 31%, with a median survival of 31.1 mo. Among them, the 1-, 3-, and 5-yr survival rates for 19 patients with regional nodal metastasis were 95, 50, and 28%, respectively, with a median survival of 36.0 mo. Conclusion. The multimodality treatment combined with IORT and MMC chemotherapy appeared to have a benefit for prognosis of advanced pancreatic adenocarcinoma.     

Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer

PURPOSE: This study was designed to analyze factors of importance for local recurrence after radical surgery for rectal cancer and to analyze course and outcome of treatment of pelvic recurrence. METHODS: One hundred seventy-five patients treated for rectal cancer with low anterior resection (LAR) or abdominoperineal resection (APR) were studied, retrospectively. Seventy-four patients had LAR and 101 had APR. RESULTS: The two groups were comparable with respect to Dukes classification, histologic differentiation, and male to female ratio. The rate of pelvic recurrence was 18 percent for LAR and 24 percent for APR (not significant). Recurrence rates were 27 percent after stapled anastomoses and 10 percent after handsewn anastomoses respectively (P=0.09). Twenty five had pelvic recurrence diagnosed without signs of distant metastatic disease. They were treated with radiotherapy, palliative operations, or analgesics. The group receiving radiotherapy had a significantly longer survival (15.9 months) compared with other groups (2.4 months;P <0.001). CONCLUSIONS: There is no difference in local recurrence rate after LAR and APR. Radiotherapy seems to increase survival in patients with an unresectable recurrence and should be offered irrespective of pain.     

Prognostic factors of long-term survival after resective procedures for pancreatic cancer

BACKGROUND/AIMS: Five-year survival rates following surgical resection of pancreatic cancer reported by the leading medical centers do not exceed 25%. It necessitates further extensive research in this area. The aim of the study was to determine prognostic factors of long-term survival after surgical treatment for pancreatic cancer. METHODOLOGY: From 1980 to 1999, 212 patients underwent surgical resection for pancreatic carcinoma. Statistical analysis of prognostic factors of long-term survival after pancreatic cancer surgery estimated by Kaplan-Meier method was carried out using multiple regression model. RESULTS: A group of 212 patients underwent surgery, where 98 had Whipple's resection, 50 Traverso, 35 total pancreatic resections, 25 left subtotal resections, and the remaining 4 segmental pancreatic body resections. Perioperative mortality was below 8%, 5-year survival approximately 15%, increasing to 65% in patients with early cancer. It was observed, that the following prognostic factors influenced the long-term survival rate: tumor size, localization, histopathologic type, and metastases to lymph nodes. The type and extent of surgery was of significance in the case of small neoplasms. CONCLUSIONS: Based on the analysis carried out, the authors conclude that the main prognostic factors for long-term survival after pancreatic cancer surgery are related to the tumor itself and show associations with the natural development biology.     

早期胃癌内镜下非治愈性切除后胃内再发的危险因素分析

目的 探讨早期胃癌（EGC）非治愈性切除后胃内再发的危险因素。方法 收集2008年10月到2018年6月,于上海仁济医院消化内镜中心行早期胃癌内镜下治疗结果为非治愈性切除,并选择继续随访的59例患者相关资料,运用单因素Logistic回归分析胃内再发危险因素。结果 随访4~77个月,中位时长40个月,出现胃内再发11例,单因素Logistic回归分析显示淋巴脉管侵犯（OR=8.63,95%CI：1.24~60.04,P=0.030）和eCura高危分级（OR=7.31,95%CI：1.05~51.10,P=0.045）是胃内再发的危险因素。结论 非治愈性切除后可考虑常规行eCura分级评估,存在淋巴脉管侵犯或eCura分级高危者不建议继续随访;eCura分级低危者可继续行内镜随访,并注意观察原病灶周围是否存在异常。