1423 Pancreaticoduodenectomies for Pancreatic Cancer

A Single-Institution Experience

Jordan M. Winter, John L. Cameron, Kurtis A. Campbell, Meghan A. Arnold, David C. Chang, JoAnn Coleman, Mary B. Hodgin, Patricia K. Sauter, Ralph H. Hruban, Taylor S. Riall, Richard D. Schulick, Michael A. Choti, Keith D. Lillemoe, Charles J. Yeo

Research output: Contribution to journalArticle

1001 Citations (Scopus)

Abstract

Pancreaticoduodenectomy (PD) with the possible addition of neoadjuvant or adjuvant therapy is the standard of care in the United States for adenocarcinoma originating in the pancreatic head, neck, and uncinate process. We reviewed 1423 patients who underwent a PD for a malignancy originating in the pancreas at our institution between 1970 and 2006. We examined 1175 PDs for ductal adenocarcinomas in greater detail. Eighteen different histological types of pancreatic cancer were identified; the most common diagnoses included ductal adenocarcinoma, neuroendocrine carcinoma, and IPMN with invasive cancer. Patients with ductal adenocarcinoma were analyzed in detail. The median age was 66 years, with patients in the present decade significantly older (68 years), on average, than patients in the three prior decades (e.g., 60 years in 1970, P = 0.02). The median tumor diameter was 3 cm; 42% of the resections had positive margins and 78% had positive lymph nodes. The perioperative morbidity was 38%. The median postoperative stay declined over time, from 16 days in the 1980s to 8 days in the 2000s (P < 0.001). The perioperative mortality declined from 30% in the 1970s to 1% in the 2000s (P < 0.001). The median survival for all patients with ductal adenocarcinoma was 18 months (1-year survival = 65 %, 2-year survival = 37%, 5-year survival = 18%). In a Cox proportional hazards model, pathological factors having a significant impact on survival included tumor diameter, resection margin status, lymph node status, and histologic grade. This is the largest single-institution experience with PD for pancreatic cancer. Patients who have cancers with favorable pathological features have a statistically significant improved long-term survival.

Original languageEnglish (US)
Pages (from-to)1199-1211
Number of pages13
JournalJournal of Gastrointestinal Surgery
Volume10
Issue number9
DOIs
StatePublished - Nov 2006
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Pancreatic Neoplasms
Adenocarcinoma
Survival
Neoplasms
Lymph Nodes
Neuroendocrine Carcinoma
Standard of Care
Proportional Hazards Models
Pancreas
Neck
Morbidity
Mortality

Keywords

  • cancer
  • ductal adenocarcinoma
  • pancreatic cancer
  • Pancreaticoduodenectomy
  • Whipple

ASJC Scopus subject areas

  • Surgery

Cite this

Winter, J. M., Cameron, J. L., Campbell, K. A., Arnold, M. A., Chang, D. C., Coleman, J., ... Yeo, C. J. (2006). 1423 Pancreaticoduodenectomies for Pancreatic Cancer: A Single-Institution Experience. Journal of Gastrointestinal Surgery, 10(9), 1199-1211. https://doi.org/10.1016/j.gassur.2006.08.018

1423 Pancreaticoduodenectomies for Pancreatic Cancer : A Single-Institution Experience. / Winter, Jordan M.; Cameron, John L.; Campbell, Kurtis A.; Arnold, Meghan A.; Chang, David C.; Coleman, JoAnn; Hodgin, Mary B.; Sauter, Patricia K.; Hruban, Ralph H.; Riall, Taylor S.; Schulick, Richard D.; Choti, Michael A.; Lillemoe, Keith D.; Yeo, Charles J.

In: Journal of Gastrointestinal Surgery, Vol. 10, No. 9, 11.2006, p. 1199-1211.

Research output: Contribution to journalArticle

Winter, JM, Cameron, JL, Campbell, KA, Arnold, MA, Chang, DC, Coleman, J, Hodgin, MB, Sauter, PK, Hruban, RH, Riall, TS, Schulick, RD, Choti, MA, Lillemoe, KD & Yeo, CJ 2006, '1423 Pancreaticoduodenectomies for Pancreatic Cancer: A Single-Institution Experience', Journal of Gastrointestinal Surgery, vol. 10, no. 9, pp. 1199-1211. https://doi.org/10.1016/j.gassur.2006.08.018
Winter, Jordan M. ; Cameron, John L. ; Campbell, Kurtis A. ; Arnold, Meghan A. ; Chang, David C. ; Coleman, JoAnn ; Hodgin, Mary B. ; Sauter, Patricia K. ; Hruban, Ralph H. ; Riall, Taylor S. ; Schulick, Richard D. ; Choti, Michael A. ; Lillemoe, Keith D. ; Yeo, Charles J. / 1423 Pancreaticoduodenectomies for Pancreatic Cancer : A Single-Institution Experience. In: Journal of Gastrointestinal Surgery. 2006 ; Vol. 10, No. 9. pp. 1199-1211.
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abstract = "Pancreaticoduodenectomy (PD) with the possible addition of neoadjuvant or adjuvant therapy is the standard of care in the United States for adenocarcinoma originating in the pancreatic head, neck, and uncinate process. We reviewed 1423 patients who underwent a PD for a malignancy originating in the pancreas at our institution between 1970 and 2006. We examined 1175 PDs for ductal adenocarcinomas in greater detail. Eighteen different histological types of pancreatic cancer were identified; the most common diagnoses included ductal adenocarcinoma, neuroendocrine carcinoma, and IPMN with invasive cancer. Patients with ductal adenocarcinoma were analyzed in detail. The median age was 66 years, with patients in the present decade significantly older (68 years), on average, than patients in the three prior decades (e.g., 60 years in 1970, P = 0.02). The median tumor diameter was 3 cm; 42{\%} of the resections had positive margins and 78{\%} had positive lymph nodes. The perioperative morbidity was 38{\%}. The median postoperative stay declined over time, from 16 days in the 1980s to 8 days in the 2000s (P < 0.001). The perioperative mortality declined from 30{\%} in the 1970s to 1{\%} in the 2000s (P < 0.001). The median survival for all patients with ductal adenocarcinoma was 18 months (1-year survival = 65 {\%}, 2-year survival = 37{\%}, 5-year survival = 18{\%}). In a Cox proportional hazards model, pathological factors having a significant impact on survival included tumor diameter, resection margin status, lymph node status, and histologic grade. This is the largest single-institution experience with PD for pancreatic cancer. Patients who have cancers with favorable pathological features have a statistically significant improved long-term survival.",
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