PALLIATIVE OPERATION FOR CANCER OF THE HEAD OF THE PANCREAS - SIGNIFICANCE OF PANCREATICODUODENECTOMY AND INTRAOPERATIVE RADIATION-THERAPY FOR SURVIVAL AND QUALITY-OF-LIFE

The benefits of a palliative operation and intraoperative radiation th erapy (IORT) for survival and quality of life (QOL) of patients with c ancer of the head of the pancreas are not clear. Survival and hospital -free survival (HFS), which are considered to be objective indicators of QOL, were studied in 13 patients who underwent palliative pancreati coduodenectomy (PD) and 32 patients who underwent surgical bypass, Alt hough there was no significant difference in the survival of patients who underwent PD or bypass (median survivals of 9 months and 7 months, respectively), HFS for 3 months or longer was achieved in 84.6% of th e patients who underwent PD, which was significantly higher than that of the 53.1% in patients who underwent surgical bypass (p < 0.05). Amo ng TNM stage III patients, a significant difference in survival was ob served between surgical bypass associated with IORT and bypass alone ( p < 0.05); the median survival time of the IORT group was 10 months, w hereas that of the control group was 5 months. In addition, HFS of 3 m onths or longer was achieved in 83.3% of patients who underwent bypass with IORT but in only 25.0% of the patients who underwent surgery alo ne (p < 0.01). The addition of IORT to palliative PD neither prolonged survival nor improved HFS. These results show the beneficial effect o f palliative PD on QOL, and the efficacy of IORT for survival and QOL was proved in cases with stage III pancreatic cancer who underwent sur gical bypass. For patients subjected to palliative PD, however, IORT i s not thought to be beneficial for either survival or QOL.