Evaluation of Outcomes after Pancreatic Cancer Resection

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive and lethal malignancies, with therapeutic management continuing to pose significant challenges. Pancreatic resection combined with systemic chemotherapy offers the only potential for long-term survival, however, the overall prognosis remains dismal, and treatment-associated complications are unfortunately common. This thesis investigates outcomes after pancreatic resection, focussing on identification and evaluation of key prognostic factors. Part I addresses short-term postoperative outcomes after pancreatic resection. Part II evaluates the prognostic value of various factors related to staging of resectable PDAC. Part III explores determinants associated with long-term survival following PDAC resection.

Several key findings emerged. Severe complications following pancreatic surgery adversely affect both short-term recovery and long-term outcomes. Although existing risk models for complications such as postoperative pancreatic fistula provide some guidance, their predictive accuracy is limited. The adoption of standardized, algorithm-based postoperative care enables early recognition and timely management of complications, which may mitigate further clinical deterioration and eventually improve long-term oncological outcomes – most notably in patients with PDAC. These observations highlight the importance of further research efforts to minimize the incidence of severe complications and to improve identification of high-risk patients undergoing pancreatic surgery, with the aim of optimizing perioperative and long-term outcomes. Another key finding was the prognostic importance of several staging-related risk factors in predicting survival following PDAC resection. Preoperative carbohydrate antigen 19-9, incomplete resection margin status, perineural invasion and TNM stages are all predictive of survival. However, current staging systems for resected PDAC lack sufficient precision to accurately stratify patient outcomes. There is a need for refinement and external validation of these staging criteria to enhance prognostication and support individualized therapeutic decision-making. Furthermore, survival outcomes for patients with locally advanced pancreatic cancer that underwent neoadjuvant treatment were comparable to those with initially resectable pancreatic cancer, supporting surgery in these selected patients. In elderly patients, surgery was safe compared to younger patients, although underuse of adjuvant therapy negatively impacted survival.

The findings presented in this thesis offer valuable insights that may support counseling of patients scheduled for pancreatic resection and ultimately aid shared decision making in pancreatic cancer care.