1. Improved survival outcomes after resection of ductal adenocarcinoma in the body and tail of the pancreas: A single center 10 years’ experience
Seong Uk Kwon, Yoo-Seok Yoon, Ho-Seong Han,
Jae Young Cho, YoungRok Choi, Jae Seong Jang
Department of Surgery, Seoul National University Bundang Hospital
Seoul National University College of Medicine

2. Background
The prognosis of pancreatic ductal adenocarcinoma (PDAC) arising from the pancreatic body and tail was known to be worse than that of PDAC arising from the pancreas head.
Recent advance in perioperative care and surgical technique favorably affected therapeutic outcome for PDAC.
There have been a few studies with a focus on survival outcome after resection of PDAC in the pancreatic body and tail.

3. Aim
To evaluate the survival outcome after surgical resection for pancreatic body and tail cancer and prognostic factors affecting the patient survival by analyzing 10-year experiences of our institution.

4. Method Study period: between January 2003 and December 2014.
86 patients who underwent distal pancreatectomy for PDAC of the body and tail.
Retrospective review of medical records.
Analysis of survival, recurrence, and prognostic factors affecting survival.

5. Results Age : 64.7 (33-82) Male : Female = 55 : 31
Neoadjuvant chemotherapy : 10 (11.6%)
Curative resection: 71 (82.5%)
Adjuvant Chemotherapy: 38 (44%)
AJCC staging
T1 (1), T2(3), T3(80), T4(2)
N1(n=47, 54.6%)
M1(n= 9)
­primary resection + liver tumorectomy: 4
primary resection + RFA for live meta: 1
palliative resection: 4

6. Survival Mean follow-up duration: 25.8 months
Median survival: 28.9 months
5-year overall survival rate: 35.1%

7. Recurrence Recurrence rate: 62.7% (54/86)
5-year disease-free survival rate: 22.7%
Site: local (14), systemic (40)
Treatment for recurrence
conservative care : 19
chemotherapy: 29
radiation: 7
resection: 4, RFA: 1
Abdominal wall 2
Retroperitoneal metastasis: 1
Lung metastasis :1
Liver: 1

8. Prognostic factors for survival
Univariate analysis
Variable N
Mean survival time
(month)
5-yrs survival
P value
Age
0.71
>65 47
54.0
42.7%
<65 39
46.7
26.3%
Gender
0.321
Male 55
57.4
40.9%
Female 31
34.8
18.0%
CEA
0.302
>5 25
46.2
28.6%
<5 52
48.9
36.2%
CA19-9
0.569
>200 35
50.9
24.7%
<200 48
43.6
39.7%
Tumor size
0.224
>2cm 4
63.8
35.4%
≤2cm 82
50.6
33.8%

9. Prognostic factors for survival
Univariate analysis
Variable N
Mean Survival Time
(month)
5-yrs survival
P value
Perineural invasion
0.03
Negative 11
81.3
61.4%
Positive 75
44.1
24.8%
Angiolymphatic invasion
0.186 52
54.7
39.8% 34
42.6
27.2%
Adjuvant CTx
0.034
Yes 38
38.8
29.1% No 48
58.4
37.8%
Chemotherapy completion
0.019
Incomplete 31
27.4
0.0%
Complete 17
81.9
63.7%
Combined resection
0.344
None 56
44.0
26.7%
Resection 30
65.3
54.3%

10. Prognostic factors for survival
Multivariate analysis
Variable HR
95%CI
P value
perineural invasion
4.91
0.011
neoadjuvant
0.54
0.406
angiolymphatic invasion
1.55
0.191
no adjuvant chemotherapy
2.684
0.003
combined resection
0.593
0.146

11. Conclusion
Aggressive surgical treatment, including combined resection and resection for metastasis or recurrence, along with perioperative chemotherapy might improve the survival outcome in patients with resected PDAC of the pancreas body and tail.
Further study with larger number of patients and longer follow-up period is needed to confirm the survival improvements of these patients in the recent decade compared to the past decades.

12. Thank you for kind attention