AN AGGRESSIVE THERAPEUTIC APPROACH TO CARCINOMA OF THE BODY AND TAIL OF THE PANCREAS

BACKGROUND. Prognosis of patients with adenocarcinoma of the pancreati c body and tail is extremely poor. Anatomically, this part of the panc reas is thin, and cancerous invasion to the retropancreatic structures occurs easily. The majority of patients have residual tumor in the re troperitoneal tissues after conventional distal pancreatectomy. METHOD S. Between 1962 and 1979, 10 patients with carcinoma of the pancreatic body underwent simple distal pancreatectomy. Between 1980 and 1990, 2 2 patients including 7 with distant metastasis underwent a more aggres sive approach intended to achieve longer survival: distal pancreatecto my with extended dissection of the lymph nodes and adjacent structures , especially into the retropancreatic space. After 1984, intraoperativ e radiation (IORT) by electron beam and chemotherapy by hepatic infusi on plus systemic injection of mitomycin C (MMC) were added for 7 patie nts without distant metastasis. RESULTS. The 10 patients who underwent pancreatectomy between 1962 and 1979 all died within 20 months after their operations. Conversely, the patients treated with an aggressive approach between 1980 and 1990 survived longer; the 5-year survival ra te for 15 patients without distant metastasis was 29%, though the 7 pa tients with distant metastasis died within 10 months of their operatio ns. There were 4 long term survivors (greater than or equal to 5 pears ); 3 of whom received IORT and chemotherapy with MMC. Invasion to the retropancreatic soft tissues was present in 95% of the resected specim ens from the 22 patients. However, invasion to the surgical margin at the posterior surface of the resected specimen was present in only 36% after extended resection of the retropancreatic structures. CONCLUSIO NS. Survival improved for this disease after distal pancreatectomy wit h extended dissection, especially of the retropancreatic structures, a djuvant IORT, and chemotherapy had been performed. (C) 1996 American C ancer Society.