A result of surgical treatment for ductal adenocarcinoma of the head of the pancreas

BACKGROUND/AIMS: Ductal adenocarcinoma of the head of the pancreas can only be cured with pancreaticoduodenectomy. However, the prognosis after resection has been poor. This study analyzed the possible prognostic factors of resected ductal adenocarcinoma through pancreaticoduodenectomy in a single institution. METHODS: Between Oct. 1994 and May. 2002, 81 patients underwent pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Perioperative and pathologic factors were analyzed with univariate and multivariate analysis. RESULTS: The overall 5-year survival rate of the 81 patients was 10.8% with median survival of 11.8 months. Ninety-six percent of the patients were in stage IIa, IIb or III. In univariate analysis, factors favoring survival were as follows: CA19-9 antigen<or=200 U/mL (p=0.0055), no preoperative biliary drainage (p=0.018), operation time<or=6.5 hr (p=0.009), R0 (curative) resection (p=0.0001), negative gross vascular invasion (p=0.0012), tumor size<or=3 cm (p=0.002), T lesion<or=T3 (p=0.0014), no tumor necrosis (p=0.0041), no duodenal invasion (p=0.0004) and postoperative chemoradiation therapy (p=0.0365). In multivariate analysis, R0 resection (p<0.001), T lesion<or=T3 (p=0.03) and no duodenal invasion (p=0.001) were independent predictors of prognosis. In 20 patients, who had T lesion<or=T3 without duodenal invasion and R0 resection, the 5-year survival rate was 67.8%. CONCLUSIONS: After pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas, a favorable 5-year survival rate can be achieved in the group of patients who have T lesion<or=T3 without duodenal invasion and R0 resection.