Pancreatic Adenocarcinoma: Complete Tumor Extirpation Improves Survival Benefit Despite Larger Tumors for Patients Who Undergo Distal Pancreatectomy and Splenectomy

Introduction Patients with pancreatic adenocarcinoma have poor survival. Presumably, tumors in the body or tail of the pancreas, due to paucity of symptoms, present later than patients with tumors in the head of the pancreas. This study was undertaken to determine if tumors amenable to complete extirpation by distal pancreatectomy/splenectomy have worse survival when compared to their proximal counterparts. Methods Since 1992, patients undergoing pancreaticoduodenectomy or distal pancreatectomy/splenectomy for pancreatic adenocarcinoma have been prospectively followed. The impact of resection was evaluated using a survival curve analysis (Mantel–Cox). Data are presented as median, mean ± SD. Results Two hundred twenty patients underwent pancreaticoduodenectomy and 33 patients underwent distal pancreatectomy/splenectomy for pancreatic adenocarcinoma. Comparing overall survival, there was not a significant difference between patients undergoing pancreaticoduodenectomy (16.8 months, 25.6 ± 26) and distal pancreatectomy/splenectomy (15.2 months, 19.7 ± 18.6), p = 0.34. Patients undergoing distal pancreatectomy/splenectomy had significantly larger tumors (4 cm, 5 ± 2.3) compared to patients undergoing pancreaticoduodenectomy (3 cm, 3 ± 1.4), p = 0.005. Conclusion Long-term survival after resection of pancreatic adenocarcinoma is poor despite the location within the pancreas. Complete tumor extirpation continues to be an independent predictor of survival, regardless of operation undertaken, despite larger tumors for patients who undergo distal pancreatectomy/splenectomy.