Details

Autor(en) / Beteiligte

• Neoptolemos, J.P.
• Stocken, D.D.
• Dunn, J.A.
• Buckels, J.
• Deakin, M.
• Sutton, R.
• Imrie, C.
• Kerr, D.J.
• Büchler for the members of Espac, M.W.

Titel

Six of the Best, Upper GI 14

Ist Teil von

• British journal of surgery, 2002, Vol.89 (S1), p.35-35

Ort / Verlag

Chichester, UK: John Wiley & Sons, Ltd

Erscheinungsjahr

2002

Link zum Volltext

Quelle

Wiley Online Library Journals Frontfile Complete

Beschreibungen/Notizen

• Aims: The ESPAC‐1‐randomized controlled trial of 541 patients with pancreatic ductal adenocarcinoma showed that adjuvant chemotherapy increased median survival compared to no chemotherapy (19.7 months versus 14.0 months; P = 0.0005), including those with R1 resection margins but chemoradiotherapy did not. The aim of this study was to determine if postoperative complications or the type of surgery affected long‐term survival. Methods: Analyses of patients on the ESPAC‐1 database by categorical, log‐rank and Cox proportional hazards modelling. Results: Operative details were available on 466 (86 per cent) patients: Kausch–Whipple (KW) was performed in 241 (52 per cent of total), pylorus‐preserving KW (PPKW) in 171 (37 per cent), distal pancreatectomy in 35 (7 per cent) and total pancreatectomy in 19 (4 per cent) patients. Postoperative complications occurred in 125/446 (28 per cent) patients including: fistula = 37, delayed gastric emptying = 24, pulmonary complications = 14, and bleeding = 11. Survival analysis showed no significant difference in survival (median, 95 per cent CI) between those that had complications (17.2, 14.0–22.2 months) and those that did not (15.7, 13.7–17.4 months; P = 0.073). Patients that had a PPKW resection had a longer survival (18.1, 16.5–21.7 months) than those that had a KW resection (14.1, 12.8–16.4 months; P < 0.001). Stepwise selection revealed that only three factors were of independent prognostic significance: tumour grade (P < 0.001), nodal status (P < 0.001) and tumour size (P = 0.013) but not PPKW (P = 0.07). Conclusions: Patients who had complications after resection for pancreatic cancer still benefited from adjuvant treatment. Moreover, there was no evidence from this trial that the more conservative PPKW resulted in reduced long‐term survival.