Long-term survival (5-20 years) after pancreatectomy for pancreatic ductal adenocarcinoma: A series of 30 patients collected from 3 institutions

OBJECTIVES:: Long-term survival after pancreatectomy for pancreatic duct adenocarcinoma has been rarely reported. Factors influencing survival are still debated. The aim of the study is to report a French multicentric series of long-term survivors after pancreatectomy for pancreatic duct adenocarcinoma. METHODS:: Data of patients who survived >5 years (February 1983-January 2000) were analyzed. All operative specimens were reviewed. Patients with intraductal-papillary-mucinous-neoplasia, cystadenocarcinoma, acinous-adenocarcinoma, neuroendocrine, or mixed tumors were excluded. RESULTS:: Long-term survivors were 20 men and 10 women, with median age of 61 years. Twenty-five patients had pancreaticoduodenectomies (6 pylorus preserving pancreatoduodenectomy [PPPD]), 3 had total pancreaticoduodenectomies, and 2 had splenopancreatectomies. Three patients had portal vein resection, 1 had hepatic artery resection-reconstruction, and 1 had segmentectomy for liver metastasis. All resections were complete macroscopic and microscopic resection (R0). Median tumor size was 30 mm. Tumors were pT2 (n = 1), pT3 (n = 24), pT4 (n = 5), 12 N+, 1 M+. Twenty patients had adjuvant radiotherapy, and 18 had concomitant chemotherapy. Median survival was 7.3 years (range, 5.2-21 years). Nineteen patients are alive, 1 with recurrence and 18 with no evidence of disease (2 had more than 20 years of follow-up). Eleven patients died, 6 from recurrence. CONCLUSIONS:: Pancreatic duct adenocarcinoma can be cured, and long-term survival after R0 curative surgery has become a reality. Long-term survivors did not fulfil the ideal prognostic criteria and even presented with advanced stage.