Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study

Hussein Fakhry; Mohamed Abdelsabor Mekky; Ahmed Khair Ibrahim; Wael Ahmed Abbas; Tarek Mohamed Elsaba; Mohamed Korany

doi:doi:10.11648/j.jctr.20150304.11

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Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study

Hussein Fakhry, Mohamed Abdelsabor Mekky, Ahmed Khair Ibrahim, Wael Ahmed Abbas, Tarek Mohamed Elsaba, Mohamed Korany

Published in Journal of Cancer Treatment and Research (Volume 3, Issue 4)

Received: 11 September 2015 Accepted: 24 September 2015 Published: 13 October 2015

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Abstract

Background: Pancreatic adenocarcinoma (PAC) is one of the most fatal human malignancies and complete surgical resection is the only treatment that offers a hope for prolonged survival. However, even after curative resection, the overall 5-year survival rate is only 10%-29%. Aim: we aimed to examine the preoperative and operative predictors for survival following radical resection of PAC. Methods: Twenty-four patients with ductal adenocarcinoma of the head of pancreas who had undergone pancreatoduodenectomy at South Egypt Cancer Institute, Assiut University, between January 2010 and December 2011, were recruited. Results: The follow-up time ranged from 2 to 36 months with a median of 14 months. Univariate analysis revealed that anorexia, weight loss, pre-operative anaemia, hypoalbuminemia, obstructive jaundice, pre-operative transfusions, WHO performance scale, presence of preoperative morbidities and tumor size were associated with the patients survival. Of the previous factors, pre-operative hemoglobin level (<10mg/dl), pre-operative serum albumin level (<30mg/dl), pre-operative transfusions (blood and albumin), and tumor size were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. Conclusion: The current study concluded that preoperative malnutrition (due to anorexia, anaemia, hypoalbumineamia and preoperative transfusions) and large tumor size (>T2) were associated with poor outcome after surgical resection.

Published in	Journal of Cancer Treatment and Research (Volume 3, Issue 4)
DOI	10.11648/j.jctr.20150304.11
Page(s)	47-52
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2015. Published by Science Publishing Group

Keywords

Adenocarcinoma, Hypoalbuminemia, Pancreas, Pancreaticoduodenectomy, Pancreatic Carcinoma, Survival Rate

References

[1]	Jemal A, Siegel R, Xu J, Ward E. Cancer statistics. CA Cancer J Clin 2010;60(5):277-300.
[2]	Wray C, Ahmad S, Matthews J, Lowy A. Surgery for pancreatic cancer: recent controversies and current practice. Gastroenterology 2005;128(6):1626-41.
[3]	Neuzillet C, Sauvanet A, Hammel P. Prognostic factors for resectable pancreatic adenocarcinoma. J Visc Surg 2011 Sep;148(4):e232-43.
[4]	Distler M, Rücker F, Hunger M, Kersting S, Pilarsky C, Saeger HD et al. Evaluation of survival in patients after pancreatic head resection for ductal adenocarcinoma. BMC Surg 2013 Apr 22; 13:12.
[5]	Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 2011;98(2):268-74.
[6]	Lundin J, Roberts P, Kuusela P, Haglund C. The prognostic value of preoperative serum levels of CA 19–9 and CEA in patients with pancreatic cancer. Br J Cancer 1994;69(3):515-9.
[7]	Van Berge Henegouwen MI, De Wit LT, Van Gulik TM, Obertop H, Gouma DJ. Incidence, risk factors and treatment of pancreatic leakage after a pancreatoduodenectomy: drainage versus resection of pancreatic remnant. J Am Coll Surg 1997; 185:18-24.
[8]	Morris DM, Ford RS. Pancreaticogastrostomy: preferred reconstruction for Whipple resection. J Surg Res 1993; 54:122-5.
[9]	Ramesh H, Thomas PG. Pancreaticojejunostomy versus pancreaticogastrostomy in reconstruction following pancreaticoduodenectomy. Aust N Z J Surg 1990; 60:973-6.
[10]	Bartoli FG, Arnone GB, Ravera G, Bachi V. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy. Review and statistical meta-analysis regarding 15 years of literature. Anticancer Res 1991; 11:1831-48.
[11]	McKay A, Mackenzie S, Sutherland FR, Bathe OF, Doig C, Dort J et al. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy. Br J Surg 2006; 93:929-36.
[12]	Wente MN, Shrikhande SV, Müller MW, Diener MK, Seiler CM, Friess H et al. Pancreaticojejunostomy versus pancreatico gastrostomy: systematic review and meta-analysis. Am J Surg 2007; 193:171-83.
[13]	Hermanek P. Staging of exocrine pancreatic carcinoma. Eur J Surg Oncol 1991;17(2):167-72.
[14]	Trede M, Schwall G, Saeger H. Survival after pancreatoduodenectomy: 118 consecutive resections without an operative mortality. AnnSurg 1990;211:447-58.
[15]	Haller D. New perspectives in the management of pancreas cancer. Semin Oncol 2003;30:3-10.
[16]	Delbeke D, Pinson C. Pancreatic tumors: role of imaging in the diagnosis, staging, and treatment. J Hepatobiliary Pancreat Surg 2004;11:4-10.
[17]	Takhar A, Palaniappan P, Dhingsa R, Lobo D. Recent developments in diagnosis of pancreatic cancer. BMJ 2004;329:668-73.
[18]	Buchler M, Wagner M, Schmied B, Uhl W, Friess H, Z’Graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 2003;138(12):1310-4.
[19]	Takai S, Satoi S, Toyokawa H, Yanagimoto H, Sugimoto N, Tsuji K et al. Clinicopathologic evaluation after resection for ductal adenocarcinoma of the pancreas: a retrospective, single institution experience. Pancreas 2003;26(3):243-9.
[20]	Perini MV, Montagnini AL, Jukemura J, Penteado S, Abdo EE, Patzina R et al. Clinical and pathologic prognostic factors for curative resection for pancreatic cancer. HPB 2008;10:356-62.
[21]	Cleary S, Gryfe R, Guindi M, Greig P, Smith L, Mackenzie R et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am CollSurg 2004;198(5):722-31.
[22]	Goonetilleke K, Siriwardena A. Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy. JOP 2006;7:5-13.
[23]	Schrader H, Menge B, Belyaev O, Uhl W, Schmidt W, Meier J. Amino acid malnutrition in patients with chronic pancreatitis and pancreatic carcinoma. Pancreas 2009;38:416-21.
[24]	Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection highlights and drawbacks. Ann Surg 2013;257:191-204.
[25]	Garcea G, Dennison AR, Pattenden CJ, Neal CP, Sutton CD, Berry DP. Survival following curative resection for pancreatic ductal adenocarcinoma. A systematic review of the literature. JOP 2008;9(2):99-132.
[26]	Phoa SS, Tilleman EH, van Delden OM, Bossuyt PM, Gouma DJ, Lameris JS. Value of CT criteria in predicting survival in patients with potentially resectable pancreatic head carcinoma. J Surg Oncol 2005; 91(1):33-40.
[27]	Yamaguchi K1, Mizumoto K, Noshiro H, Sugitani A, Shimizu S, Chijiiwa K et al. Pancreatic carcinoma: < or = 2 cm versus > 2 cm in size. Int Surg 1999;84(3):213-9.
[28]	Pongprasobchai S, Pannala R, Smyrk TC, Bamlet W, Pitchumoni S, Ougolkov A et al. Long-term survival and prognostic indicators in small (< or = 2 cm) pancreatic cancer. Pancreatology 2008;8(6):587-92.
[29]	Neoptolemos JP, Stocken DD, Dunn JA, Almond J, Beger HG, Pederzoli P et al; European Study Group for Pancreatic Cancer. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234(6):758-68.
[30]	Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2. Randomized control trial evaluating survival, mortality and morbidity. Ann Surg 2002;3:355-68.
[31]	Kaťuchová J, Bober J, oňak J. Postoperative complications and survival rates for pancreatic cancer patients. Wiener klinische Wochenschrift 2011;123:94-9.

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APA Style

Hussein Fakhry, Mohamed Abdelsabor Mekky, Ahmed Khair Ibrahim, Wael Ahmed Abbas, Tarek Mohamed Elsaba, et al. (2015). Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study. Journal of Cancer Treatment and Research, 3(4), 47-52. https://doi.org/10.11648/j.jctr.20150304.11

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ACS Style

Hussein Fakhry; Mohamed Abdelsabor Mekky; Ahmed Khair Ibrahim; Wael Ahmed Abbas; Tarek Mohamed Elsaba, et al. Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study. J. Cancer Treat. Res. 2015, 3(4), 47-52. doi: 10.11648/j.jctr.20150304.11

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AMA Style

Hussein Fakhry, Mohamed Abdelsabor Mekky, Ahmed Khair Ibrahim, Wael Ahmed Abbas, Tarek Mohamed Elsaba, et al. Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study. J Cancer Treat Res. 2015;3(4):47-52. doi: 10.11648/j.jctr.20150304.11

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@article{10.11648/j.jctr.20150304.11,
  author = {Hussein Fakhry and Mohamed Abdelsabor Mekky and Ahmed Khair Ibrahim and Wael Ahmed Abbas and Tarek Mohamed Elsaba and Mohamed Korany},
  title = {Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study},
  journal = {Journal of Cancer Treatment and Research},
  volume = {3},
  number = {4},
  pages = {47-52},
  doi = {10.11648/j.jctr.20150304.11},
  url = {https://doi.org/10.11648/j.jctr.20150304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20150304.11},
  abstract = {Background: Pancreatic adenocarcinoma (PAC) is one of the most fatal human malignancies and complete surgical resection is the only treatment that offers a hope for prolonged survival. However, even after curative resection, the overall 5-year survival rate is only 10%-29%. Aim: we aimed to examine the preoperative and operative predictors for survival following radical resection of PAC. Methods: Twenty-four patients with ductal adenocarcinoma of the head of pancreas who had undergone pancreatoduodenectomy at South Egypt Cancer Institute, Assiut University, between January 2010 and December 2011, were recruited. Results: The follow-up time ranged from 2 to 36 months with a median of 14 months. Univariate analysis revealed that anorexia, weight loss, pre-operative anaemia, hypoalbuminemia, obstructive jaundice, pre-operative transfusions, WHO performance scale, presence of preoperative morbidities and tumor size were associated with the patients survival. Of the previous factors, pre-operative hemoglobin level (<10mg/dl), pre-operative serum albumin level (<30mg/dl), pre-operative transfusions (blood and albumin), and tumor size were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. Conclusion: The current study concluded that preoperative malnutrition (due to anorexia, anaemia, hypoalbumineamia and preoperative transfusions) and large tumor size (>T2) were associated with poor outcome after surgical resection.},
 year = {2015}
}

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TY  - JOUR
T1  - Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study
AU  - Hussein Fakhry
AU  - Mohamed Abdelsabor Mekky
AU  - Ahmed Khair Ibrahim
AU  - Wael Ahmed Abbas
AU  - Tarek Mohamed Elsaba
AU  - Mohamed Korany
Y1  - 2015/10/13
PY  - 2015
N1  - https://doi.org/10.11648/j.jctr.20150304.11
DO  - 10.11648/j.jctr.20150304.11
T2  - Journal of Cancer Treatment and Research
JF  - Journal of Cancer Treatment and Research
JO  - Journal of Cancer Treatment and Research
SP  - 47
EP  - 52
PB  - Science Publishing Group
SN  - 2376-7790
UR  - https://doi.org/10.11648/j.jctr.20150304.11
AB  - Background: Pancreatic adenocarcinoma (PAC) is one of the most fatal human malignancies and complete surgical resection is the only treatment that offers a hope for prolonged survival. However, even after curative resection, the overall 5-year survival rate is only 10%-29%. Aim: we aimed to examine the preoperative and operative predictors for survival following radical resection of PAC. Methods: Twenty-four patients with ductal adenocarcinoma of the head of pancreas who had undergone pancreatoduodenectomy at South Egypt Cancer Institute, Assiut University, between January 2010 and December 2011, were recruited. Results: The follow-up time ranged from 2 to 36 months with a median of 14 months. Univariate analysis revealed that anorexia, weight loss, pre-operative anaemia, hypoalbuminemia, obstructive jaundice, pre-operative transfusions, WHO performance scale, presence of preoperative morbidities and tumor size were associated with the patients survival. Of the previous factors, pre-operative hemoglobin level (<10mg/dl), pre-operative serum albumin level (<30mg/dl), pre-operative transfusions (blood and albumin), and tumor size were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. Conclusion: The current study concluded that preoperative malnutrition (due to anorexia, anaemia, hypoalbumineamia and preoperative transfusions) and large tumor size (>T2) were associated with poor outcome after surgical resection.
VL  - 3
IS  - 4
ER  -

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Author Information

Hussein Fakhry

Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Mohamed Abdelsabor Mekky

Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
Ahmed Khair Ibrahim

Community Health School, Faculty of Medicine, Assiut University, Assiut, Egypt
Wael Ahmed Abbas

Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
Tarek Mohamed Elsaba

Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Mohamed Korany

General Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt

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APA Style

Hussein Fakhry, Mohamed Abdelsabor Mekky, Ahmed Khair Ibrahim, Wael Ahmed Abbas, Tarek Mohamed Elsaba, et al. (2015). Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study. Journal of Cancer Treatment and Research, 3(4), 47-52. https://doi.org/10.11648/j.jctr.20150304.11

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ACS Style

Hussein Fakhry; Mohamed Abdelsabor Mekky; Ahmed Khair Ibrahim; Wael Ahmed Abbas; Tarek Mohamed Elsaba, et al. Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study. J. Cancer Treat. Res. 2015, 3(4), 47-52. doi: 10.11648/j.jctr.20150304.11

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AMA Style

Hussein Fakhry, Mohamed Abdelsabor Mekky, Ahmed Khair Ibrahim, Wael Ahmed Abbas, Tarek Mohamed Elsaba, et al. Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study. J Cancer Treat Res. 2015;3(4):47-52. doi: 10.11648/j.jctr.20150304.11

Copy | Download

@article{10.11648/j.jctr.20150304.11,
  author = {Hussein Fakhry and Mohamed Abdelsabor Mekky and Ahmed Khair Ibrahim and Wael Ahmed Abbas and Tarek Mohamed Elsaba and Mohamed Korany},
  title = {Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study},
  journal = {Journal of Cancer Treatment and Research},
  volume = {3},
  number = {4},
  pages = {47-52},
  doi = {10.11648/j.jctr.20150304.11},
  url = {https://doi.org/10.11648/j.jctr.20150304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20150304.11},
  abstract = {Background: Pancreatic adenocarcinoma (PAC) is one of the most fatal human malignancies and complete surgical resection is the only treatment that offers a hope for prolonged survival. However, even after curative resection, the overall 5-year survival rate is only 10%-29%. Aim: we aimed to examine the preoperative and operative predictors for survival following radical resection of PAC. Methods: Twenty-four patients with ductal adenocarcinoma of the head of pancreas who had undergone pancreatoduodenectomy at South Egypt Cancer Institute, Assiut University, between January 2010 and December 2011, were recruited. Results: The follow-up time ranged from 2 to 36 months with a median of 14 months. Univariate analysis revealed that anorexia, weight loss, pre-operative anaemia, hypoalbuminemia, obstructive jaundice, pre-operative transfusions, WHO performance scale, presence of preoperative morbidities and tumor size were associated with the patients survival. Of the previous factors, pre-operative hemoglobin level (<10mg/dl), pre-operative serum albumin level (<30mg/dl), pre-operative transfusions (blood and albumin), and tumor size were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. Conclusion: The current study concluded that preoperative malnutrition (due to anorexia, anaemia, hypoalbumineamia and preoperative transfusions) and large tumor size (>T2) were associated with poor outcome after surgical resection.},
 year = {2015}
}

Copy | Download

TY  - JOUR
T1  - Pre-Operative and Operative Predictors of Survival of Resectable Cancer Head of Pancreas: A Retrospective Study
AU  - Hussein Fakhry
AU  - Mohamed Abdelsabor Mekky
AU  - Ahmed Khair Ibrahim
AU  - Wael Ahmed Abbas
AU  - Tarek Mohamed Elsaba
AU  - Mohamed Korany
Y1  - 2015/10/13
PY  - 2015
N1  - https://doi.org/10.11648/j.jctr.20150304.11
DO  - 10.11648/j.jctr.20150304.11
T2  - Journal of Cancer Treatment and Research
JF  - Journal of Cancer Treatment and Research
JO  - Journal of Cancer Treatment and Research
SP  - 47
EP  - 52
PB  - Science Publishing Group
SN  - 2376-7790
UR  - https://doi.org/10.11648/j.jctr.20150304.11
AB  - Background: Pancreatic adenocarcinoma (PAC) is one of the most fatal human malignancies and complete surgical resection is the only treatment that offers a hope for prolonged survival. However, even after curative resection, the overall 5-year survival rate is only 10%-29%. Aim: we aimed to examine the preoperative and operative predictors for survival following radical resection of PAC. Methods: Twenty-four patients with ductal adenocarcinoma of the head of pancreas who had undergone pancreatoduodenectomy at South Egypt Cancer Institute, Assiut University, between January 2010 and December 2011, were recruited. Results: The follow-up time ranged from 2 to 36 months with a median of 14 months. Univariate analysis revealed that anorexia, weight loss, pre-operative anaemia, hypoalbuminemia, obstructive jaundice, pre-operative transfusions, WHO performance scale, presence of preoperative morbidities and tumor size were associated with the patients survival. Of the previous factors, pre-operative hemoglobin level (<10mg/dl), pre-operative serum albumin level (<30mg/dl), pre-operative transfusions (blood and albumin), and tumor size were found to influence the overall survival on the multivariate Cox Hazard Regression analysis. Conclusion: The current study concluded that preoperative malnutrition (due to anorexia, anaemia, hypoalbumineamia and preoperative transfusions) and large tumor size (>T2) were associated with poor outcome after surgical resection.
VL  - 3
IS  - 4
ER  -

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