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Influence of surgical resection and post-operative complications on survival following adjuvant treatment for pancreatic cancer in the ESPAC-1 randomized controlled trial

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Bassi, C., Stocken, D. D., Olah, A., Friess, H., Buckels, J., Hickey, H., Dervenis, C., Dunn, Janet A., Deakin, M., Carter, R., Ghaneh, P., Neoptolemos, J. P. and Büchler, M. W. (2005) Influence of surgical resection and post-operative complications on survival following adjuvant treatment for pancreatic cancer in the ESPAC-1 randomized controlled trial. Digestive Surgery, 22 (5). pp. 353-363. doi:10.1159/000089771

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Official URL: https://doi.org/10.1159/000089771

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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 (χ 2 LR = 15.1, p < 0.001). KW patients were more likely however to have R1 margins (67 (24%) vs. 29 (16%), χ 2 = 4.59, p = 0.032), poorly differentiated tumours (70 (26%) vs. 19 (10%), χ 2 = 18.65, p < 0.001) and positive lymph nodes (165 (60%) vs. 81 (44%), χ 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. Copyright © 2005 S. Karger AG.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Journal or Publication Title: Digestive Surgery
Publisher: S. Karger AG
ISSN: 0253-4886
Official Date: 2005
Dates:
DateEvent
2005Published
1 January 2005Accepted
Volume: 22
Number: 5
Page Range: pp. 353-363
DOI: 10.1159/000089771
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

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