• Oliver Strobel, Philipp Lorenz, Ulf Hinz, Matthias Gaida, Anna-Katharina König, Thomas Hank, Willem Niesen, J Ö Rg Kaiser, Mohammed Al-Saeedi, Frank Bergmann, Christoph Springfeld, Christoph Berchtold, Markus K Diener, Martin Schneider, Arianeb Mehrabi, Beat P Müller-Stich, Thilo Hackert, Dirk Jager, and Markus W Büchler.
• Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
• Ann. Surg. 2022 May 1; 275 (5): 962-971.

ObjectiveTo determine actual five-year survival (5YS) rates associated with a strategy of upfront surgery and adjuvant therapy in pancreatic ductal adenocarcinoma (PDAC).BackgroundThe rate of actual 5YS in PDAC remains controversial. Available data is restricted to cohorts acquired over several decades and series of resection after patient selection by neoadjuvant therapy.MethodsAll patients undergoing upfront resection for resectable and borderline-resectable PDAC from 10/2001 to 12/2011 were identified from a prospective database. Actual overall survival was assessed after a follow-up of at least 5 years. Uni- and multivariable logistic regression analyses were performed.ResultsMedian survival of 937 patients was 22.1 months. The actual 5YS rate was 17.0% (n = 159) including 89 (9.5%) patients without evidence of disease >5 years after resection. 5YS rates in patients with or without adjuvanttherapy were 18.8% vs. 12.2%, respectively. Tumorgrading, number of positive lymph nodes, a context of intraductal papillary mucinous neoplasia, and vascular resections were independently associated with 5YS. Patient-related parameters and CA 19-9 levels were associated with observed survival up to 3 years, but lost relevance thereafter. The extent of lymph node involvement was the strongest predictor of 5YS. Patients with pN0R0 had a 5YS rate of 38.2%. in patients with exclusively favorable factors the observed 5YS rate was above 50%.ConclusionsThis is the largest series of long-term survivors with histologically confirmed PDAC. With upfront resection and adjuvant therapy an actual overall 5YS rate of 18.8% can be expected. in favorable subgroups actual 5YS is above 50%.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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