Ductal adenocarcinoma of the pancreas: clinicopathologic features and survival.

AIMS AND BACKGROUND: The prognosis after surgical resection for pancreatic cancer has not been clearly defined because conflicting results have been reported. METHODS: Fifty-five patients who underwent surgical resection for pancreatic carcinoma between 1970 and 1987 were retrospectively reviewed to determine factors influencing long-term survival. RESULTS: The actuarial 5-year survival rate for all 55 patients was 12.5%. Type of operation, tumor stage, direct extension into adjacent organs, grading and lymph node involvement were found to significantly influence survival. Age, sex, tumor site, size, invasion into peripancreatic tissue, invasion of lymphatic vessels and small veins, perineural infiltration, tumor necrosis, round cell infiltrate at the tumor margin, associated chronic pancreatitis, and atypia of pancreatic ductal epithelium demonstrated no predictive capacity. No 5-year survival was observed among the patients who underwent vascular resection. Three of 9 patients who underwent left-sided pancreatectomy for cancer of the tail of the pancreas survived more than 5 years. Multivariate analysis confirmed that lymph node involvement, moderate-poor histologic tumor differentiation, and treatment with total pancreatectomy were significantly associated with a worse prognosis. CONCLUSIONS: Lymph node status, grading of the tumor and type of operation have a significant impact on prognosis in resected pancreatic cancer.