ADJUVANT THERAPY FOLLOWING PANCREATIC RESECTION FOR PANCREATIC DUCT CARCINOMA - A PROSPECTIVE RANDOMIZED STUDY

Background/Aims: This study was made to determine the efficacy of loco regional immunochemotherapy in the treatment of pancreatic ductal carc inoma. Material and Methods: From November 1991 to June 1996, eighty p atients with a diagnosis of pancreatic duct carcinoma underwent pancre atic resection. Patients were divided into two groups, Group A and Gro up B. Both groups received a standard operative procedure of extended subtotal pancreatectomy with regional lymphadenectomy of the celiac ax is, the hepatoduodenal ligament and the superior mesenteric vessels. H owever, Group B patients had two arterial catheters implanted at the e nd of the operative procedure: one via the splenic artery, after its l igation near the origin at the celiac axis and directed towards the sp leen; the second catheter was implanted into a side arterial branch of the middle colic artery into the superior mesenteric artery. Results: Group B patients have a significantly greater survival (30 months) co mpared to Group A patients (16.8 months). The proportion of alive pati ents between both Groups is much higher for Group's B patients (92% ve rsus 55%). Grading of the tumor, size of the tumor, and presence of po sitive lymph nodes were seen to he very important factors affecting ov erall survival in Group A patients, but not in Group B patients. It is impressive that from 25 Group A patients with lymph node involvement, only 8 are presently alive versus 25 alive of 28 total Group B patien ts with positive lymph nodes. Conclusion: Locoregional immunochemother apy as an adjuvant modality following pancreatic resection. offers imp ressive advantages in. terms of survival regardless of stage, lymph in volvement, and tumor size. This therapy deserves further attention and consideration in the treatment of Pancreatic Duct Carcinoma.