Younghwan Kim1, Song Cheol Kim2, Ki Byoung Song3, Jayoun Kim4, Dae Ryong Kang4, Jae Hoon Lee3, Kwang-Min Park3, Young-Joo Lee3. 1. Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, South Korea. 2. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. Electronic address: drksc@amc.seoul.kr. 3. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea. 4. Department of Medical Humanities and Social Medicine, Office of Biostatistics, Ajou University School of Medicine, Suwon, South Korea.
Abstract
BACKGROUND: Palliative resection of stage IV pancreatic ductal adenocarcinoma (PDAC) has not shown its benefit until now. In our retrospective review, we compared the results of palliative resection to non-resection. METHODS: Between 2000 and 2009, metastasis of PDAC was confirmed in the operating room in 150 patients. 35 underwent palliative resection (resection group; R) and 115 did bypass or biopsy. 35 patients (biopsy or bypass group: NR) in the 115 patients were matched with the patients undergoing resection for tumor size and the metastasis of peritoneal seeding. Demographic, clinical, operative data and survival were analyzed. RESULTS: There was no significant difference of major complication (Clavien-Dindo classification 3-5) between two groups. There was no 30-day mortality in either group. More patients in R received postoperative chemotherapy (82.9% vs. 57.1%; P = 0.019). Multivariate analysis showed resection and postoperative chemotherapy as independent factor related to survival (hazard ratio, 0.44; 95% CI, 0.25-0.76; P = 0.003). Patients in R showed better survival rates compared to those in NR (P < 0.001). CONCLUSION: Our study suggests resection for stage IV PDAC can be associated with increased survival. In patients of stage IV PDAC, palliative resection with chemotherapy could have some benefit in selected patients.
BACKGROUND: Palliative resection of stage IV pancreatic ductal adenocarcinoma (PDAC) has not shown its benefit until now. In our retrospective review, we compared the results of palliative resection to non-resection. METHODS: Between 2000 and 2009, metastasis of PDAC was confirmed in the operating room in 150 patients. 35 underwent palliative resection (resection group; R) and 115 did bypass or biopsy. 35 patients (biopsy or bypass group: NR) in the 115 patients were matched with the patients undergoing resection for tumor size and the metastasis of peritoneal seeding. Demographic, clinical, operative data and survival were analyzed. RESULTS: There was no significant difference of major complication (Clavien-Dindo classification 3-5) between two groups. There was no 30-day mortality in either group. More patients in R received postoperative chemotherapy (82.9% vs. 57.1%; P = 0.019). Multivariate analysis showed resection and postoperative chemotherapy as independent factor related to survival (hazard ratio, 0.44; 95% CI, 0.25-0.76; P = 0.003). Patients in R showed better survival rates compared to those in NR (P < 0.001). CONCLUSION: Our study suggests resection for stage IV PDAC can be associated with increased survival. In patients of stage IV PDAC, palliative resection with chemotherapy could have some benefit in selected patients.
Authors: Claudio Bassi; Christos Dervenis; Giovanni Butturini; Abe Fingerhut; Charles Yeo; Jakob Izbicki; John Neoptolemos; Michael Sarr; William Traverso; Marcus Buchler Journal: Surgery Date: 2005-07 Impact factor: 3.982
Authors: Süleyman Yedibela; Jonas Gohl; Valentina Graz; Mona Kathrin Pfaffenberger; Susanne Merkel; Werner Hohenberger; Thomas Meyer Journal: Ann Surg Oncol Date: 2005-08-18 Impact factor: 5.344
Authors: Koert Kuhlmann; Steve de Castro; Tjarda van Heek; Olivier Busch; Thomas van Gulik; Hugo Obertop; Dirk Gouma Journal: Surgery Date: 2006-02 Impact factor: 3.982
Authors: B Schniewind; B Bestmann; R Kurdow; J Tepel; D Henne-Bruns; F Faendrich; B Kremer; T Kuechler Journal: Ann Surg Oncol Date: 2006-09-29 Impact factor: 5.344
Authors: Chandrajit P Raut; Jennifer F Tseng; Charlotte C Sun; Huamin Wang; Robert A Wolff; Christopher H Crane; Rosa Hwang; Jean-Nicolas Vauthey; Eddie K Abdalla; Jeffrey E Lee; Peter W T Pisters; Douglas B Evans Journal: Ann Surg Date: 2007-07 Impact factor: 12.969
Authors: Lei Huang; Lina Jansen; Yesilda Balavarca; Masoud Babaei; Lydia van der Geest; Valery Lemmens; Liesbet Van Eycken; Harlinde De Schutter; Tom B Johannesen; Maja Primic-Žakelj; Vesna Zadnik; Marc G Besselink; Petra Schrotz-King; Hermann Brenner Journal: BMC Med Date: 2018-08-21 Impact factor: 8.775
Authors: Florentine E F Timmer; Bart Geboers; Sanne Nieuwenhuizen; Evelien A C Schouten; Madelon Dijkstra; Jan J J de Vries; M Petrousjka van den Tol; Martijn R Meijerink; Hester J Scheffer Journal: Cancers (Basel) Date: 2021-03-31 Impact factor: 6.639