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Lookup NU author(s): Dr Deborah Stocken
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Background/Aims: The influence of type of surgery and occurrence of post-operative complications on survival following adjuvant therapy for pancreatic cancer are uncertain. Methods: Cox proportional hazard modelling was used to investigate the influence of type of surgery and the presence of complications on survival in conjunction with clinico-pathological variables in the 550 patients of the ESPAC-1 adjuvant randomized controlled trial. Results: Standard Kausch-Whipple (KW) was performed in 282 (54%) patients, 186 (35%) had a pylorus-preserving (PP) KW, 39 (7%) had a distal pancreatectomy and 21 (4%) had a total pancreatectomy. Post-operative complications were reported in 140 (27%) patients. PP-KW patients survived longer with a median (95% CI) survival of 19.9 (17.3, 23.1) months compared to 14.8 (13.0, 16.7) for KW patients (=χ2LR = 15.1, p < 0.001). KW patients were more likely however to have R1 margins (67 (24%) vs. 29 (16%), =χ2 = 4.59, p = 0.032), poorly differentiated tumours (70 (26%) vs. 19 (10%), =χ2 = 18.65, p < 0.001) and positive lymph nodes (165 (60%) vs. 81 (44%), =χ2 = 11.32, p < 0.001). Post-operative complications did not significantly affect survival. Independent prognostic factors were tumour grade, nodal status and tumour size but not type of surgery or post-operative complications. There was a survival benefit for chemotherapy irrespective of the type of surgery or post-operative complications. Conclusions: The KW and PP-KW procedures did not significantly influence the hazard of death in the presence of tumour staging, demonstrating that ESPAC-1 surgeons showed good judgement in their choice of operation. Post-operative complications did not adversely affect the survival benefit from adjuvant chemotherapy.
Author(s): Bassi C, Stocken DD, Olah A, Friess H, Buckels J, Hickey H, Dervenis C, Dunn JA, Deakin M, Carter R, Ghaneh P, Neoptolemos JP, Büchler MW, for the members of the European Study Group for Pancreatic Cancer (ESPAC)
Publication type: Article
Publication status: Published
Journal: Digestive Surgery
Year: 2005
Volume: 22
Issue: 5
Pages: 353-363
Print publication date: 01/01/2005
ISSN (print): 0253-4886
ISSN (electronic): 1421-9883
Publisher: S. Karger AG
URL: http://dx.doi.org/10.1159/000089771
DOI: 10.1159/000089771
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