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Surgical resection offers the only potential cure for pancreatic tumor. The goal of the present study is to determine complications associated with pancreatic resection and to describe their influence on the survival rate for pancreatic cancer patients.
Between 1996 and 2009, the findings of 125 pancreatic cancer patients were analyzed in a prospec...
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... In 2 European nationals [33,34] the rate was from 8% to 12% over the last 5 years. In a recent report from the surgical service at a European university hospital [35] the resection rate was 11.6%. It is therefore practical to assume that the resection rate is 10% in the studies where the original TN of the group is not reported in order to estimate the TN accordingly and divide the percentage by 2.5-3 where the actuarial KM only has been published. ...
Objective . The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be $79,800 per patient and for each resection $164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage. Methods . Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented. Results . The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial percentage is on average 2.75 higher. Detailed information on the original group (TN), number of resections, and actual number of survivors is reported in only 10.6% of the papers. Repetition occurs when the patients from a certain year are reported several times from the same institution or include survivors from many institutions or countries. Each 5-year survivor may be reported several times. Conclusion . Assuming a 10% resection rate and correcting for repetitions and the life table percentage the overall actual survival rate is hardly more than 0.3%.
... Several authors have reported that the presence of postoperative complications can affect survival after pancreatic cancer resection [30,31]. In our study, the method of pancreatic reconstruction (PJ or PG) and POPF did not affect the overall survival and this agrees with Wente MN et al [12]. ...
Background: Pancreatic adenocarcinoma (PAC) is one of the most fatal human malignancies and complete surgical resection is the only treatment that offers a hope for prolonged survival. However, even after curative resection, the overall 5-year survival rate is only 10%-29%. Aim: we aimed to examine the preoperative and operative predictors for survival following radical resection of PAC. Methods: Twenty-four patients with ductal adenocarcinoma of the head of pancreas who had undergone pancreatoduodenectomy at South Egypt Cancer Institute, Assiut University, between January 2010 and December 2011, were recruited. Results: The follow-up time ranged from 2 to 36 months with a median of 14 months. Univariate analysis revealed that anorexia, weight loss, pre-operative anaemia, hypoalbuminemia, obstructive jaundice, pre-operative transfusions, WHO performance scale, presence of preoperative morbidities and tumor size were associated with the patients survival. Of the previous factors, pre-operative hemoglobin level (<10mg/dl), pre-operative serum albumin level (<30mg/dl), pre-operative transfusions (blood and albumin), and tumor size were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. Conclusion: The current study concluded that preoperative malnutrition (due to anorexia, anaemia, hypoalbumineamia and preoperative transfusions) and large tumor size (>T2) were associated with poor outcome after surgical resection.
... Several authors have reported that the presence of postoperative complications can affect survival after pancreatic cancer resection. [38,39] In patients with complications, the median survival time was 12 months as compared to 18 months in patients without complications. We also found that postoperative complications adversely affect survival. ...
Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life.
This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test.
Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin < 30g/dl, pre-operative hemoglobin < 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival.
PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.
Aim: To show whether single nucleotide polymorphisms (SNPs) of Epidermal growth factor (EGF)-61*A/G, Transforming growth factor beta 1 (TGF-B1) -509*T/C and Tumor necrosis factor-alpha (TNF-A) -308*A/G are associated with the survival rate after pancreatic cancer surgery and with the frequency of post-operative complications. Patients and Methods: EGF 61*A/G, TGF-B1-509*T/C and TNF-A-308*A/G genotypes were analyzed in patients who underwent pylorus-preserving pancreaticoduonectomy for pancreatic carcinoma and were determined by means of Polymerase Chain Reaction Restriction Fragment Length Polymorphism (PCR-RFLP). The association of each genetic polymorphism with clinical and pathological data of the patients and early tumor recurrence were evaluated. Results: A significantly lower median survival duration was found in EGF 61*AA homozygotes, as compared to the AG heterozygous group. There was also a significantly lower median survival duration in the TNF-A-308* AA homozygote group as compared to the AG and GG groups. Survival duration in patients had no correlation with TGF-B1 -509*T/C polymorphism. There was a significantly lower median survival duration in the TNF-A -308* AA homozygous group, as compared to the AG and GG group in a Cox proportional hazard model. The frequency of the TGF-B1 T-allele was higher among patients with leakage of the pancreatic anastomosis. The frequency of the TGF-B1 TC genotype was significantly higher among patients who developed leakage of the biliodigestive anastomosis as compared with the TGF-B1 CC genotype. The frequency of TGF-B1 T-carriers (i.e. TT+TC) was significantly higher among patients with leakage of the biliodigestive anastomosis, as compared to these with the TGF-B1 CC genotype. In a Cox proportional hazard model, only wound infection had a significant correlation with long-term survival duration of patients with pancreatic cancer. Conclusion: There appears to be a significant correlation of the EGF-61* AA and of the TNF-A -308* AA polymorphism with lower survival duration in patients with resectable pancreatic carcinoma. The presence of wound infection was associated with poor prognosis. TGF-B1-509* T-carrying genotypes were more frequent in paitents with severe postoperative complications.
Aim: To show whether single nucleotide polymorphisms (SNPs) of Epidermal growth factor (EGF)-61(*)A/G, Transforming growth factor beta 1 (TGF-B1) - 509(*)T/C and Tumor necrosis factor-alpha (TNF-A) -308(*)A/G are associated with the survival rate after pancreatic cancer surgery and with the frequency of post-operative complications.
EGF 61(*)A/G, TGF-B1-509(*)T/C and TNF-A-308(*)A/G genotypes were analyzed in patients who underwent pylorus-preserving pancreaticoduonectomy for pancreatic carcinoma and were determined by means of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). The association of each genetic polymorphism with clinical and pathological data of the patients and early tumor recurrence were evaluated.
A significantly lower median survival duration was found in EGF 61(*)AA homozygotes, as compared to the AG heterozygous group. There was also a significantly lower median survival duration in the TNF-A-308(*) AA homozygote group as compared to the AG and GG groups. Survival duration in patients had no correlation with TGF-B1 -509(*)T/C polymorphism. There was a significantly lower median survival duration in the TNF-A -308(*) AA homozygous group, as compared to the AG and GG group in a Cox proportional hazard model. The frequency of the TGF-B1 T-allele was higher among patients with leakage of the pancreatic anastomosis. The frequency of the TGF-B1 TC genotype was significantly higher among patients who developed leakage of the biliodigestive anastomosis as compared with the TGF-B1 CC genotype. The frequency of TGF-B1 T-carriers (i.e. TT+TC) was significantly higher among patients with leakage of the biliodigestive anastomosis, as compared to these with the TGF-B1 CC genotype. In a Cox proportional hazard model, only wound infection had a significant correlation with long-term survival duration of patients with pancreatic cancer.
There appears to be a significant correlation of the EGF-61(*) AA and of the TNF-A -308(*) AA polymorphism with lower survival duration in patients with resectable pancreatic carcinoma. The presence of wound infection was associated with poor prognosis. TGF-B1-509(*) T-carrying genotypes were more frequent in paitents with severe post-operative complications.
