Introduction : There are conflicting results regarding whether pancreas head cancer and distal pancreatic cancer have similar prognosis. The study aims to compare the survival and prognostic factors of pancreatic cancer according to the location.

Methods : 658 patients operated with curative intent for pancreatic cancer between 2005 and 2016 in Seoul National University Hospital were examined. Demographics, clinicopathologic, and survival data were retrieved for analysis. Survival analysis and univariate/multivariate analyses were performed.

Results : There were no differences in terms of R status and receiving adjuvant treatment. The body/tail cancers had more T3/4 tumors (25.9% vs. 17.0%, p=0.007) whereas the head cancers had more T1/2 tumors (83.1% vs. 74.1%, p=0.007). Head cancers had more nodal metastasis (64.2% vs. 57.5%) but was insignificant (p=0.100).
The body/tail cancers showed significantly longer median survival (28 vs. 22 months, p=0.025) and higher 5YSR (25.0% vs. 16.9%). Survival comparison across each T/N category, and stage showed no differences except for T2. T2 body/tail cancers displayed significantly better outcome (median survival; 31 vs. 21 months, p=0.006) than T2 head cancers. Among documented recurrences, distant metastasis was more frequent than local recurrence in the body/tail compared to the head (91.1% vs. 78.4%, p=0.013).

Conclusions : Despite having more of T1/2 tumors, the head cancer had worse outcome than the body/tail cancer. In addition, tumors showed different recurrence patterns. Further, while they share some prognostic factors, there are some that are distinctive of the location. Therefore, there may be a need to consider pancreas head cancer and body/tail cancer as cancers of distinct tumor biology.