Survival Trends for Resectable Pancreatic Cancer Using a Multidisciplinary Conference: the Impact of Post-operative Chemotherapy



Despite advances in various treatment modalities, surgical resection for pancreatic ductal adenocarcinoma (PDA) remains the only curative treatment. Data remains limited regarding survival rates for resectable PDA when managed by a multidisciplinary pancreas conference (MDPC). The aim of this study is to assess survival rates, identify significant predictors of mortality, and assess the benefits of adjuvant chemotherapy for resectable PDA following presentation at a MDPC.


All patients presented from April 2013 to August 2016 with resectable PDA were discussed at a MDPC at a tertiary care center and were followed prospectively until November 2017. Survival analysis was performed using Kaplan-Meier for age, tumor size, tumor differentiation, T-stage, lymph node status, and completion of adjuvant chemotherapy cycles. Independent predictors of survival were determined using multivariate Cox regression modeling.


After MDPC consensus and exclusions, total of 64 patients underwent successful surgery. Amongst this cohort, 1-, 2-, and 3-year survival was 78.13%, 46.30%, and 27.27%, respectively. A total of 37 patients (58%) initiated and 16 patients (25%) finished chemotherapy following surgery. Log-rank analysis revealed that tumor size, age, surgical margins, lymph node status, and number of adjuvant chemotherapy cycles received significantly influenced post-operative survival. Tumor size (p < 0.001), lymph node status (p = 0.035), and number of adjuvant chemotherapy cycles (p = 0.041) remained significant after multivariate Cox regression model.


Our results suggest that patients with PDA with tumor size > 50 mm and/or lymph node involvement have poor outcomes despite being surgically resectable. Successful completion of adjuvant chemotherapy has better survival outcomes as compared with incomplete or no adjuvant chemotherapy. The role of alternative management such as down-staging with neoadjuvant therapy should be considered.

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  1. 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.

    Article  Google Scholar 

  2. 2.

    Kleeff J, Korc M, Apte M, et al. Pancreatic cancer. Nat Rev Dis Primers. 2016;2:16022.

    Article  Google Scholar 

  3. 3.

    Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530–6.

    Article  Google Scholar 

  4. 4.

    Sharma C, Eltawil KM, Renfrew PD, et al. Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990-2010. World J Gastroenterol. 2011;17:867–97.

    Article  Google Scholar 

  5. 5.

    Yeo TP. Demographics, epidemiology, and inheritance of pancreatic ductal adenocarcinoma. Semin Oncol. 2015;42:8–18.

    Article  Google Scholar 

  6. 6.

    Hurton S, MacDonald F, Porter G, et al. The current state of pancreatic cancer in Canada: incidence, mortality, and surgical therapy. Pancreas. 2014;43:879–85.

    Article  Google Scholar 

  7. 7.

    Hsu C, Wolfgang C, Laheru D, et al. Early mortality risk score: identification of poor outcomes following upfront surgery for resectable pancreatic cancer. J Gastrointest Surg. 2012;16:753–61.

    Article  Google Scholar 

  8. 8.

    Hoffe S, Rao N, Shridhar R. Neoadjuvant vs adjuvant therapy for resectable pancreatic cancer: the evolving role of radiation. Semin Radiat Oncol. 2014;24:113–25.

    Article  Google Scholar 

  9. 9.

    Nienhuijs SW, van den Akker SA, de Vries E, et al. Nationwide improvement of only short-term survival after resection for pancreatic cancer in the Netherlands. Pancreas. 2012;41:1063–6.

    Article  Google Scholar 

  10. 10.

    Barugola G, Partelli S, Marcucci S, et al. Resectable pancreatic cancer: who really benefits from resection? Ann Surg Oncol. 2009;16:3316–22.

    Article  Google Scholar 

  11. 11.

    Merkow RP, Bilimoria KY, Tomlinson JS, et al. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg. 2014;260:372–7.

    Article  Google Scholar 

  12. 12.

    Wilkowski R, Wolf M, Heinemann V. Primary advanced unresectable pancreatic cancer. Recent Results Cancer Res. 2008;177:79–93.

    CAS  Article  Google Scholar 

  13. 13.

    Valeri S, Borzomati D, Nappo G, et al. Complete pathological response after FOLFIRINOX for locally advanced pancreatic cancer. The beginning of a new era? Case report and review of the literature. Pancreatology. 2014;14:425–30.

    CAS  Article  Google Scholar 

  14. 14.

    Springett GM, Hoffe SE. Borderline resectable pancreatic cancer: on the edge of survival. Cancer Control. 2008;15:295–307.

    Article  Google Scholar 

  15. 15.

    Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.

    Article  Google Scholar 

  16. 16.

    Lamb BW, Sevdalis N, Mostafid H, et al. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol. 2011;18:3535–43.

    CAS  Article  Google Scholar 

  17. 17.

    Lamb B, Green JS, Vincent C, et al. Decision making in surgical oncology. Surg Oncol. 2011;20:163–8.

    CAS  Article  Google Scholar 

  18. 18.

    Taylor C, Munro AJ, Glynne-Jones R, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ. 2010;340:951.

    Article  Google Scholar 

  19. 19.

    Dietz DW. Multidisciplinary management of rectal cancer: the OSTRICH. J Gastrointest Surg. 2013;17:1863–8.

    Article  Google Scholar 

  20. 20.

    Wille-Jorgensen P, Bulow S. The multidisciplinary team conference in rectal cancer--a step forward. Color Dis. 2009;11:231–2.

    CAS  Article  Google Scholar 

  21. 21.

    Rao B, Syed A, Singh S, et al. Performance of a multidisciplinary pancreas cancer conference in predicting and managing resectable pancreatic cancer. Pancreas. 2019;48:80–4.

    Article  Google Scholar 

  22. 22.

    Groot VP, Rezaee N, Wu W, et al. Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2018;267:936–45.

    Article  Google Scholar 

  23. 23.

    Neoptolemos JP, Dunn JA, Stocken DD, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001;358:1576–85.

    CAS  Article  Google Scholar 

  24. 24.

    Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.

    CAS  Article  Google Scholar 

  25. 25.

    de Geus SW, Bliss LA, Eskander MF, et al. A tale of two cities: reconsidering adjuvant radiation in pancreatic cancer care. J Gastrointest Surg. 2016;20:85–92.

    Article  Google Scholar 

  26. 26.

    Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110:1227–34.

    Article  Google Scholar 

  27. 27.

    Labori KJ, Katz MH, Tzeng CW, et al. Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma—a population-based cohort study. Acta Oncol. 2016;55:265–77.

    CAS  Article  Google Scholar 

  28. 28.

    Tzeng CW, Tran Cao HS, Lee JE, et al. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg. 2014;18:16–24.

    Article  Google Scholar 

  29. 29.

    Xia BT, Habib DA, Dhar VK, et al. Early recurrence and omission of adjuvant therapy after pancreaticoduodenectomy argue against a surgery-first approach. Ann Surg Oncol. 2016;23:4156–64.

    Article  Google Scholar 

  30. 30.

    Merkow RP, Bilimoria KY, Tomlinson JS, et al. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg. 2014;260:372–8.

    Article  Google Scholar 

  31. 31.

    Mayo SC, Gilson MM, Herman JM, et al. Management of patients with pancreatic adenocarcinoma: national trends in patient selection, operative management, and use of adjuvant therapy. J Am Coll Surg. 2012;214:33–45.

    Article  Google Scholar 

  32. 32.

    Wu W, He J, Cameron JL, et al. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol. 2014;21:2873–81.

    Article  Google Scholar 

  33. 33.

    Piperdi M, McDade TP, Shim JK, et al. A neoadjuvant strategy for pancreatic adenocarcinoma increases the likelihood of receiving all components of care: lessons from a single-institution database. HPB (Oxford). 2010;12:204–10.

    Article  Google Scholar 

  34. 34.

    Evans DB, Multidisciplinary Pancreatic Cancer Study G. Resectable pancreatic cancer: the role for neoadjuvant/preoperative therapy. HPB (Oxford). 2006;8:365–8.

    Article  Google Scholar 

  35. 35.

    Papalezova KT, Tyler DS, Blazer DG III. Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer? J Surg Oncol. 2012;106:111–9.

    Article  Google Scholar 

  36. 36.

    Cooper AB, Parmar AD, Riall TS, et al. Does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates? J Gastrointest Surg. 2015;19:80–6.

    Article  Google Scholar 

  37. 37.

    Cooper AB, Holmes HM, des Bordes JK, et al. Role of neoadjuvant therapy in the multimodality treatment of older patients with pancreatic cancer. J Am Coll Surg. 2014;219:111–20.

    Article  Google Scholar 

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NMC is supported by the National Institute of General Medical Sciences of the National Institutes of Health (USA) under award number T32GM008208.

Specific Author Contributions

Conception and design: ARS, GK, ST

Acquisition of data: ARS, AD, SM, HW, DA, SS, DM, AL, AK, MM, MD, AK, ST

Analysis and interpretation of data: ARS, NMC, ZH, AD, ST

Drafting the manuscript: ARS, NMC, GB, ST

Final approval of the version to be published: ARS, NMC, ZH, AD, GB, GK, SM, HW, DA, SS, DM, AL, AK, MM, MD, AK, ST. All authors read and approved the final manuscript.

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Correspondence to Shyam Thakkar.

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Syed, A.R., Carleton, N.M., Horne, Z. et al. Survival Trends for Resectable Pancreatic Cancer Using a Multidisciplinary Conference: the Impact of Post-operative Chemotherapy. J Gastrointest Canc 51, 836–843 (2020).

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  • Resectable pancreatic cancer
  • Multidisciplinary pancreatic cancer conference
  • Survival outcomes
  • Adjuvant chemotherapy
  • Neoadjuvant therapy