Predictors for survival in an international cohort of patients undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma

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• dc.contributor.author Korrel, M.
• dc.contributor.author Lof, S.
• dc.contributor.author van Hilst, J.
• dc.contributor.author Alseidi, A.
• dc.contributor.author Boggi, U.
• dc.contributor.author Busch, O.R.
• dc.contributor.author van Dieren, S.
• dc.contributor.author Edwin, B.
• dc.contributor.author Fuks, D.
• dc.contributor.author Hackert, T.
• dc.contributor.author Keck, T.
• dc.contributor.author Khatkov, I.
• dc.contributor.author Malleo, G.
• dc.contributor.author Poves Prim, José Ignacio
• dc.contributor.author Sahakyan, M.A.
• dc.contributor.author Bassi, C.
• dc.contributor.author Abu Hilal, Mohammed
• dc.contributor.author Besselink, M.G.
• dc.contributor.author European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
• dc.date.accessioned 2021-05-20T07:10:30Z
• dc.date.available 2021-05-20T07:10:30Z
• dc.date.issued 2021
• dc.description.abstract Background: Surgical factors, including resection of Gerota's fascia, R0-resection, and lymph node yield, may be associated with survival after distal pancreatectomy (DP) for pancreatic ductal adenocarcinoma (PDAC), but evidence from large multicenter studies is lacking. This study aimed to identify predictors for overall survival after DP for PDAC, especially those related to surgical technique. Patients and methods: Data from an international retrospective cohort including patients from 11 European countries and the USA who underwent DP for PDAC (2007-2015) were analyzed. Cox proportional hazard analyses were performed and included Gerota's fascia resection, R0 resection, lymph node ratio, extended resection, and a minimally invasive approach. Results: Overall, 1200 patients from 34 centers with median follow-up of 15 months [interquartile range (IQR) 5-31 months] and median survival period of 30 months [95% confidence interval (CI), 27-33 months] were included. Gerota's fascia resection [hazard ratio (HR) 0.74; p = 0.019], R0 resection (HR 0.70; p = 0.006), and decreased lymph node ratio (HR 0.28; p < 0.001) were associated with improved overall survival, whereas extended resection (HR 1.75; p < 0.001) was associated with worse overall survival. A minimally invasive approach did not improve survival as compared with an open approach (HR 1.14; p = 0.350). Adjuvant chemotherapy (HR 0.67; p = 0.003) was also associated with improved overall survival. Conclusions: This international cohort identified Gerota's fascia resection, R0 resection, and decreased lymph node ratio as factors associated with improved overall survival during DP for PDAC. Surgeons should strive for R0 resection and adequate lymphadenectomy and could also consider Gerota's fascia resection in their routine surgical approach.
• dc.format.mimetype application/pdf
• dc.identifier.citation Korrel M, Lof S, van Hilst J, Alseidi A, Boggi U, Busch OR, et al. Predictors for survival in an international cohort of patients undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2021 Feb; 28(2): 1079-87. DOI: 10.1245/s10434-020-08658-5
• dc.identifier.doi http://dx.doi.org/10.1245/s10434-020-08658-5
• dc.identifier.issn 1068-9265
• dc.identifier.uri http://hdl.handle.net/10230/47623
• dc.language.iso eng
• dc.publisher Springer
• dc.rights Copyright © The Author(s) 2020. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Pàncrees -- Cirurgia
• dc.subject.keyword Pàncrees -- Tumors
• dc.subject.keyword Adenocarcinoma
• dc.title Predictors for survival in an international cohort of patients undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion