The role of tumor location in pancreatic cancer on perioperative outcome and long-term survival

Abstract Introduction Pancreatic cancer has a low survival. The aim of this study was to analyze the role of tumor location on perioperative outcome and survival. Method Data on all patients with resected pancreatic ductal adenocarcinoma (PDAC) identified in the Swedish National Pancreatic and Periampullary Cancer Registry 2010-2020 were included. Tumor locations in the head, body and tail were compared. A multivariable Cox survival analysis was conducted adjusting for age, gender, ASA classification, TNM7 stage, neoadjuvant chemotherapy, R0-status, grade of differentiation and date of operation. Result In total, 2355 patients were included, 1834 with tumor in the head, 216 in the body and 305 in the tail. Tumors in the head were more often T3 (72% vs 56% vs 56%, P < 0.001) and had more advanced lymph node involvement, N1 (79% vs 59% vs 50%, P <0.001). Moreover, they more frequently had resection of veins (31% vs 20% vs 8%, P < 0,001) and higher intraoperative bleeding (500 ml vs 350 ml vs 300 ml, P < 0.001). R0 resection was less common in head tumors (45% vs 59% vs 63%, P < 0.001). The unadjusted 5-year survival for tail tumors was twice as high as for head tumors (23% vs 34% vs 46%). In the multivariable adjusted analysis, tumor location in the tail was an independent prognostic factor HR 0.75 (95% CI 0.63-0.89). Discussion Tumors in the head of the pancreas had a more advanced stage. Tumor location in the tail was an independent predictor of longer survival.