Long-term survival after pancreaticoduodenectomy in patients with ductal adenocarcinoma of the pancreatic head

Background: Pancreatic ductal adenocarcinoma(PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to systemic treatment. Complete tumor resection remains the cornerstone of modern multimodal strategies aiming at long-term survival. This study was performed to investigate the overall rate of long-term survival(LTS) and its contributing factors. Methods: This was a retrospective single-center analysis of consecutive patients undergoing pancreaticoduodenectomy(PD) for PDAC between 2007 and 2014 at the St. Josef Hospital, Ruhr University Bochum, Germany. Clinical and laboratory parameters were assessed and evaluated for prediction of LTS with Cox regression analysis. Results: The overall rate of LTS after PD for PDAC was 20.4%(34/167). Median survival was 24 months regardless of adjuvant treatment. Carbohydrate antigen 19-9 levels, tumor grade, lymph vessel invasion, perineural invasion and reduced general condition were significantly associated with LTS in univariate analysis( P 0.05). Serum levels of carbohydrate antigen 19-9, American Joint Committee on Cancer stage, tumor grade, abdominal pain, male, exocrine pancreatic insufficiency and duration of postoperative hospital stay were independent predictors of cancer survival in multivariable analysis. Conclusions: Cancer related characteristics are associated with LTS in multimodally treated patients after curative PDAC surgery.