Impact of tumor location on resectability and survival for pancreatic ductal adenocarcinoma

Abstract

2001 to 2016 were retrospectively collected. Clinicopathologic factors were correlated with the primary outcome of overall survival in univariate and multivariate analyses. Results: 330 patients were surgically treated between 2001 and 2016. The majority of patients presented with early stage disease (Stage I-15.9%, Stage II-81.4%, Stage III-1.7%). Twenty-one patients (10.3%) received neoadjuvant therapy and 221 (72.5%) completed adjuvant therapy. Median survival was 26.8 months, with 1-,3-,and 5-year overall survival of 77.1%, 41.2%, and 28.4%. Median follow-up time was 21.7 months. Pathologic findings of lymphovascular invasion (p < 0.0001), perineural invasion (p = 0.0089), and lymph node invasion (p < 0.0001) were significantly associated with worse survival on univariate analysis. Tumor size >1.5 cm (p = 0.0063), lymph node ratio >0.1 (p = 0.0003), and a non-R0 resection (p = 0.0002) were also significantly associated with worse survival. Tumor stage, major surgical complications (Clavien-Dindo 3), and local tumor recurrence were independently associated with worse survival on multivariate analysis (p < 0.05). There were no significant associations between survival and operation type, preoperative presenting symptoms, or neoadjuvant or adjuvant therapy. Conclusion: This is the largest series analyzing PDAC-NBT who underwent surgical therapy. Improved survival is associated with favorable tumor biology and operative outcomes.