RESULTS OF EXTENSIVE SURGERY FOR PANCREATIC-CARCINOMA

BACKGROUND. Since 1973, 210 patients with pancreatic carcinoma have un dergone surgery in our clinic, including 144 with carcinoma of the hea d of the pancreas. Of these 144 patients, macroscopic curative resecti ons were performed on 53 (36.8%). Five patients (9.4%) died within 30 postoperative days, and an additional 3 (5.7%) died within 60 days. Th e overall median survival was 13 months. Eight of the patients who und erwent macroscopic curative resection survived 5 years, giving a 5-yea r survival rate of 27.4% using the Kaplan-Meier method. The 5-year sur vival rate was 39.7% after a microscopically curative resection and 0% after a microscopically noncurative resection. METHODS. Outcome was c ompared based on the extent of pancreatic cancer by constructing survi val curves according to the general rules published by the Japan Pancr eas Society. RESULTS. There was no statistically significant differenc e in survival based on tumor size or stage. However, there was a signi ficant difference in the survival of patients with the absence (so) or presence (se) of invasion to the anterior capsule of the pancreas, th e absence (rpo) or presence (rpe) of invasion of the retroperitoneal t issue, the absence (ew(0)) or presence (ew(2)) of invasion at the surg ical margin of resection, and the extent (n(0) to n(2)) of lymph node metastasis. CONCLUSIONS. The results of this study suggest that extend ed radical pancreatectomy may be indicated for patients with pancreati c carcinoma because standard dissection may fail when the tumor has sp read to the retroperitoneum or extrapancreatic nerve plexus. (C) 1996 American Cancer Society.