Korean J Hepatobiliary Pancreat Surg.  2014 Nov;18(4):138-146. 10.14701/kjhbps.2014.18.4.138.

Prognostic factors associated with early mortality after surgical resection for pancreatic adenocarcinoma

Affiliations
  • 1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. drksc@amc.seoul.kr

Abstract

BACKGROUNDS/AIMS
Identifying pancreatic cancer patients at high risk of early mortality following surgical resection for pancreatic cancer is important to make optimal treatment decisions in multidisciplinary setting. The purpose of this study was to identify the factors related to early mortality in patients who underwent pancreatic resection for pancreatic adenocarcinoma.
METHODS
We reviewed our institution's experience with all consecutive patients who underwent pancreatectomy for pancreatic adenocarcinoma from January 2000 to December 2010. One thousand patients were eligible for our study. Fifty-three patients who did not meet the study criteria were excluded. Based on 12 months after surgery, patients were divided into early mortality group or the remaining group. We performed logistic regression analysis to identify predictors of early mortality.
RESULTS
Among 947 patients who met our study criteria, 302 (31.9%) early mortality (defined as experiencing death within 12 months after surgery) occurred. Multivariate analysis revealed that patient age and surgery time period were statistically significant predictors of early mortality within six months after surgery. Poorly differentiated tumor and adjuvant chemotherapy were statistically significant predictors of early mortality within 12 months after surgery. Total pancreatectomy and lymphovascular invasion were significant (p<0.05) prognostic factors of early mortality within 6 or 12 months after surgery.
CONCLUSIONS
We suggest followings to avoid early mortality after pancreatic resection: patients with multiple risk factors related to early mortality after pancreatectomy should be considered for alternative treatment; patient's general condition and surgical technique improvement are important; and adjuvant therapy should be taken into consideration.

Keyword

Pancreas; Pancreatic cancer; Pancreatectomy; Survival; Prognosis

MeSH Terms

Adenocarcinoma*
Chemotherapy, Adjuvant
Humans
Logistic Models
Mortality*
Multivariate Analysis
Pancreas
Pancreatectomy
Pancreatic Neoplasms
Prognosis
Risk Factors

Figure

  • Fig. 1 Kaplan-Meier survival curves for patient survival. (A) Disease-free survival rate of all 947 patients who underwent surgical resection for pancreatic adenocarcinoma. Landmark line showing 12 months; (B) Comparison of the disease-free survival rate stratified according to the time period during which surgery was performed.

  • Fig. 2 Cumulative survival curve of patients who died within 12 months after pancreatic resection (n=302) showing a more rapid downward pattern in the survival curve after 6 months.


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