![]() However, there is controversy around most of these, and the majority of prior studies have been small, single-institution experiences, limiting the power and generalizability of the results. Factors found to be potentially associated with survival outcomes have included: 1) demographic factors, such as age, gender, and race 2) perioperative factors, such as type of resection, estimated blood loss, packed red blood cell transfusions, operative time, surgeon’s experience, decade of resection, and adjuvant therapy and 3) histopathologic factors, such as tumor size, status, and DNA ploidy, histologic grade, blood vessel or neural invasion, lymph node status, and resection margins. In an effort to seek other explanations for the improved survival rates, several studies have analyzed the determinants of long-term survival in postresection pancreatic cancer patients. 11–18 While some of this improved success may be attributed to increased experience with the procedure and advances in perioperative care, decrease in procedure-related mortality cannot be the sole explanation for this increase in 5-year survival from less than 5% to greater than 20%. 7–10 Recent studies from centers of excellence specializing in the care of cancer patients, however, have reported improved rates of long-term survival for patients with adenocarcinoma of the head of the pancreas after pancreaticoduodenectomy, with 5-year survival rates exceeding 20%. As recently as a decade ago, patients who underwent resection for cure had survival outcomes that were approximately equivalent to those who received palliative bypass procedures. 6 This slim chance for cure is further borne out by the historical results of this procedure. 2–5Īccording to data from the National Cancer Data Base, pancreaticoduodenectomy, also known as the Whipple procedure, was the most commonly performed cancer-directed operation, but it resulted in a 5-year survival rate of only 3% in 1985. 1 Unfortunately, due to the late presentation of symptoms, only 10% to 20% of these individuals are candidates for surgical resection, which remains the only viable chance for cure of this highly aggressive and lethal disease. ![]() 1 Based on nationwide statistics, less than 5% of all patients diagnosed with pancreatic cancer can expect to live for more than 5 years. In 1999, incidence and mortality rates were identical, accounting for 28,600 deaths that year, and making it the fourth leading cause of cancer death for both men and women in the United States. Pancreatic cancer is a devastating disease. Multivariate analyses indicated the strongest predictors of survival were adjuvant combined chemoradiotherapy, small tumors (<2 cm in diameter), negative lymph nodes, well-differentiated histology, undergoing surgery in a teaching hospital, and high socioeconomic status. Higher socioeconomic status was associated both with an increased likelihood of receiving adjuvant therapy and improved overall survival. ![]() Prognostic variables significantly diminishing survival on univariate analysis included African American race, treatment not in a teaching hospital, lack of adjuvant chemoradiation therapy, as well as histopathologic factors that included tumor size larger than 2 cm in diameter, moderate to poor histologic grade, and positive lymph node metastases. Survival appears to be gradually improving over time, concomitant with a rise in the proportion of patients undergoing surgery in teaching centers. Median survival for the overall study population was 17.6 months, with 1- and 3-year survival rates of 60.1% and 34.3%, respectively.
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