Rationale of the so-called extended resection for pancreatic invasive ductal carcinoma

It has generally been recognized that for adenocarcinoma of the pancreas, s urgical resection provides the only chance for cure. In this study, we have analyzed the longterm survival of 141 patients with invasive ductal adenoc arcinoma of the pancreas who received macroscopically curative resection. M ultivariate analysis demonstrated that comprehensive stage of the tumor, cu rability of the resection, and adjuvant radiation therapy were independent prognostic factors. Pancreatectomy in this study was done with an extensive retroperitoneal clearance of pam-aortic lymph node and nerve tissues, so-c alled extended resection. Survival curves of these patients revealed that t he RO resection is essentially necessary for long-term survival. Survival c urve without microscopic lymph node metastasis was significantly better tha n that with node metastasis; however, 3 patients with node metastasis have been alive for more than 3 years. The survival curve of the patients who re ceived adjuvant radiation therapy was better than of those who underwent su rgery alone, and postoperative regional chemotherapy with continuous 5-FU i nfusion decreased hepatic metastases within 6 months. The results suggest t hat local recurrence of pancreatic cancer might possibly be controlled by e xtended resection and adjuvant irradiation, and early development of hepati c metastases might be controlled with regional chemotherapy.