SP2.6 Histological TNM stage and five-year survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma
Thomas Russell, Peter Labib, Somaiah Aroori,- Surgery
Abstract
Aims
Patients with a pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head may be offered pancreatoduodenectomy (PD) providing they are suitable candidates. Unfortunately, recurrence rates are high following this operation and few patients achieve long-term survival. This study aimed to investigate and quantify the relationship between histological tumour, node and metastasis stage, and five-year survival.
Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for malignancy (29 centres from 8 countries, n=1484). PDAC patients were grouped by their T stage, N stage and M stage, and five-year survival rates were compared using Fisher’s exact test.
Results
A total of 885 patients (59.6%) had PDAC confirmed histologically. Five-year survival was 57.4%, 46.0%, 17.0% and 32.0% in patients with T1, T2, T3 and T4 disease, respectively (unavailable: 7 patients). T1-2 patients (vs T3-4) had significantly higher rates of five-year survival (OR: 4.8, 95% CI: 3.3-7.0). N0 patients (vs N1-2) had significantly higher rates of five-year survival (OR: 4.5, 95% CI: 3.2-6.3). M0 patients (vs M1) also had higher five-year survival rates but this was not quite significant due to the small sample size of the M1 group (OR: 3.8, 25.7% vs 8.3%, p=0.06).
Conclusion
In our multicentre study of patients who underwent PD for PDAC, increasing T and N histological stages were found to correlate with reduced five-year survival. The figures provided can be used to guide the consenting process and predict outcomes in individual patients.