Long-term survival after resection for XXXX . Is it really improving?

@entity1 @entity788 @entity1124 @entity5 @entity3 @entity420
OBJECTIVE: The authors review their recent experience with resected @entity1124 . SUMMARY BACKGROUND DATA: @entity1124 has traditionally had a 5-year survival rate less than 10% after curative resection. Recently, several groups have reported markedly improved 5-year survival rates (approaching 25%) for @entity1 undergoing curative resection. METHODS: Institutional experience with 186 consecutive @entity1 (1981-1991) with pathologic diagnoses of @entity420 undergoing pancreatic resection was reviewed. Histologic specimens of all 3-year survivors (n = 31) were re-reviewed by two pathologists, one internal and one external; nonductal @entity788 then were excluded. RESULTS: After histologic re-review, 12 @entity1 did not have @entity420 , leaving a total of 174 @entity1 for analysis (102 @entity1 , 72 @entity1 ; mean age 63 years, range 34-82 years). Mean follow-up was 22 months (range 4-109). Classical pancreaticoduodenectomy was performed in 71%, pylorus-preserving resection in 9%, and total pancreatectomy in 20%. Hospital mortality was 3%. Twenty-eight @entity1 (16%) had macroscopically incomplete resections; 98 (56%) had lymph node @entity3 within the resected specimens, and 21 @entity1 (12%) had extensive perineural invasion. Overall actuarial 5-year survival was 6.8%. Five-year survival was greater for node-negative versus node-positive @entity1 (14% vs. 1%, p < 0.001), and for smaller (< 2 cm) versus larger @entity5 (20% vs. 1%, p < 0.001). The 5-year survival for the subset of @entity1 with negative nodes and no perineural or duodenal invasion (69 @entity1 ) was 23% (p < 0.001). Mean survival of the 12 excluded @entity1 was 53 +/- 7 months compared with 17.5 +/- 1 months in the 174 @entity1 with ductal @entity788 . CONCLUSIONS: Five-year survival for @entity1 undergoing pancreatic resection for lesions deemed to be clinically "curable" intraoperatively and histologically reviewed/confirmed to be @entity1124 is approximately 7%. Survival is greater (23%) in the subset of @entity1 with negative nodes and no duodenal or perineural invasions. Pathologic review of all @entity1 with @entity788 is mandatory if survival data are to be meaningful.
