Published online Dec 28, 2015. doi: 10.3748/wjg.v21.i48.13574
Peer-review started: July 4, 2015
First decision: July 19, 2015
Revised: August 11, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: December 28, 2015
Processing time: 177 Days and 6.4 Hours
Long-term outcome data in pancreatic adenocarcinoma are predominantly based on surgical series, as resection is currently considered essential for long-term survival. In contrast, five-year survival in non-resected patients has rarely been reported. In this report, we examined the incidence and natural history of ≥ 5-year survivors with non-resected pancreatic adenocarcinoma. All patients with pancreatic adenocarcinoma who received oncologic therapy alone without surgery at our institution between 1995 and 2009 were identified. Non-resected ≥ 5-year survivors represented 2% (11/544) of all non-resected patients undergoing treatment for pancreatic adenocarcinoma, and 11% (11/98) of ≥ 5-year survivors. Nine patients had localized tumor and 2 metastatic disease at initial diagnosis. Disease progression occurred in 6 patients, and the local tumor bed was the most common site of progression. Six patients suffered from significant morbidities including recurrent cholangitis, second malignancy, malnutrition and bowel perforation. A rare subset of patients with pancreatic cancer achieve long-term survival without resection. Despite prolonged survival, morbidities unrelated to the primary cancer were frequently encountered and a close follow-up is warranted in these patients. Factors such as tumor biology and host immunity may play a key role in disease progression and survival.
Core tip: Five-year survival in patients with pancreatic cancer without curative resection is rare and has not been well described in the literature. At our institution from 1995 to 2009, non-resected ≥ 5-year survivors represented 2% (11/544) of all non-resected patients with pancreatic adenocarcinoma, and 11% (11/98) of ≥ 5-year survivors. These patients were mostly younger than 70 years of age, had excellent performance status and responded favorably to chemotherapy but suffered significant morbidities such as biliary sepsis. We speculate that tumor biology and host immunity play important roles on disease progression and survival.