Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial

Vol. 22, No. 5, 2005

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Original Paper

Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial
C. Bassi^a, D.D. Stocken^b, A. Olah^c, H. Friess^d, J. Buckels^e, H. Hickey^f, C. Dervenis^g, J.A. Dunn^b, M. Deakin^h, R. Carterⁱ, P. Ghaneh^j, J.P. Neoptolemos^j, M.W. Büchler^d, for the members of the European Study Group for Pancreatic Cancer (ESPAC)

^aSurgical Department, Endocrine and Pancreatic Unit, University of Verona, Verona, Italy;
^bCancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK;
^cPetz Aladar Hospital, Gyor, Hungary;
^dUniversity of Heidelberg, Heidelberg, Germany;
^eDepartment of Surgery, Queen Elizabeth Hospital, Birmingham;
^fCancer Research UK Trials Office, Liverpool University, Liverpool, UK;
^gAgia Olga Hospital, Athens, Greece;
^hDepartment of Surgery, North Staffordshire Hospital, Stoke on Trent;
ⁱDepartment of Surgery, Glasgow Royal Infirmary, Glasgow, and
^jDivision of Surgery and Oncology, University of Liverpool, Liverpool, UK

Address of Corresponding Author

Dig Surg 2005;22:353-363 (DOI: 10.1159/000089771)

Key Words

Surgery
Resection
Post-operative complications
Pancreas
Pancreatic
Cancer
Chemotherapy
Chemoradiotherapy
Randomized controlled trial

Abstract

Background/Aims: The influence of type of surgery and occurrence of post-operative complications on survival following adjuvant therapy for pancreatic cancer are uncertain. Methods: Cox proportional hazard modelling was used to investigate the influence of type of surgery and the presence of complications on survival in conjunction with clinico-pathological variables in the 550 patients of the ESPAC-1 adjuvant randomized controlled trial. Results: Standard Kausch-Whipple (KW) was performed in 282 (54%) patients, 186 (35%) had a pylorus-preserving (PP) KW, 39 (7%) had a distal pancreatectomy and 21 (4%) had a total pancreatectomy. Post-operative complications were reported in 140 (27%) patients. PP-KW patients survived longer with a median (95% CI) survival of 19.9 (17.3, 23.1) months compared to 14.8 (13.0, 16.7) for KW patients ( chi ²_LR = 15.1, p < 0.001). KW patients were more likely however to have R1 margins (67 (24%) vs. 29 (16%), chi ² = 4.59, p = 0.032), poorly differentiated tumours (70 (26%) vs. 19 (10%), chi ² = 18.65, p < 0.001) and positive lymph nodes (165 (60%) vs. 81 (44%), chi ² = 11.32, p < 0.001). Post-operative complications did not significantly affect survival. Independent prognostic factors were tumour grade, nodal status and tumour size but not type of surgery or post-operative complications. There was a survival benefit for chemotherapy irrespective of the type of surgery or post-operative complications. Conclusions: The KW and PP-KW procedures did not significantly influence the hazard of death in the presence of tumour staging, demonstrating that ESPAC-1 surgeons showed good judgement in their choice of operation. Post-operative complications did not adversely affect the survival benefit from adjuvant chemotherapy.

Author Contacts

Prof. J.P. Neoptolemos
Division of Surgery and Oncology, University of Liverpool
5th Floor UCD Building, Daulby Street
Liverpool L69 3GA (UK)
Tel. +44 151 706 4175, Fax +44 151 706 5798, E-Mail j.p.neoptolemos@liverpool.ac.uk

Article Information

Received: April 6, 2005
Accepted: August 5, 2005
Published online: November 16, 2005
Number of Print Pages : 11
Number of Figures : 3, Number of Tables : 4, Number of References : 64

Medline Abstract (ID 16293966)

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