Prognostic factors and long-term outcomes of resected pancreatic adenocarcinoma: A comparison between two decades.

318 Background: There have been improvements in short and long-term survival rates for patients with resected pancreatic adenocarcinoma over time The main objective of this study was to evaluate differences in long-term survival in a cohort of patients with resected pancreatic adenocarcinoma. Methods: This is a retrospective cohort study of patients who underwent pancreatic resection for pancreatic adenocarcinoma over 2 decades at a high volume academic centre. Univariate and multivariate analysis using Cox proportional hazards model were performed to evaluate prognostic factors associated with long-term survival. Time trend analyses were performed to evaluate differences between decades. Results: There were 489 patients identified, 179 patients during the early (1991-2000) and 310 during the recent decade (2001-2010). Main differences between early and recent decade were: node-positive disease rate (59% vs. 69%), number of lymph nodes collected (median 7 vs. 17), perioperative mortality (6.7% vs. 1.6%) and percentage of patients receiving adjuvant therapy (33% vs. 68%), respectively. There were no differences in sex distribution, age, margin positivity rate or tumor grade. In the multivariate analysis, node, margin status, tumor grade, adjuvant therapy and decade of resection were independently associated with overall survival for the entire cohort. Patients who received adjuvant therapy had better median overall survival: 17 [95% confidence interval (CI): 14-22] vs. 26 months (95% CI: 24-31). Median overall survival for the early and recent decade were 16 months (95% CI: 14-20) and 27 months (95% CI: 24-30, p<0.001), respectively. Conclusions: Factors associated with improved long-term survival remain comparable over time: low tumor grade, node and margin negative disease. Short and long-term survival for patients with resected pancreatic adenocarcinoma has improved in the recent decade. This is due to decreased perioperative mortality and increase use of adjuvant therapy.