Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Hazem M. Zakaria, Anwar Mohamed, Ayman Alsebaey, Hazem Omar, Dina ELazab, Nahla K. Gaballa


Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.

Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.

Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection margin (P=0.04), and positive lymph nodes in pathology after surgery (P=0.03). In multivariate analysis the independent risk factors for survival were; high preoperative CA 19-9 (P=0.042), tumor size >3cm (P=0.038), poorly differentiated tumor in histopathology (P=0.045).

Conclusions: High tumor marker CA19-9, tumor size, and grade are significant risk factors for poor survival after resection of PDAC and should be taken into account in the selection of patients for surgery to improve the outcome.


Pancreatic duct adenocarcinoma, Pancreaticoduodenectomy, Postoperative complications, Pancreatic fistula, Survival

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