Effect of curative versus palliative surgical treatment for stage III pancreatic cancer patients

During the last decade, significant progress has been made in pancreaticodu odenectomy for patients with pancreatic carcinoma. Pancreatic resection per formed by surgeons in tertiary referral centres is therefore justified, whi le the indications for pancreatic resection could be extended in patients w ith advance stages of disease. The aim of our study is to compare the effec t of curative (pancreaticoduodenectomy) versus palliative surgery in patien ts with stage III pancreatic cancer, during a 20-years period. We retrospec tively reviewed the charts of 58 consecutive patients with stage III ductal adenocarcinoma of the head of the pancreas. 23 patients underwent pancreat oduodenectomy with curative intent while the remaining 35 patients had surg ery for palliative purposes (combined biliary and gastric bypass was perfor med in 83%), The hospital mortality rate was similar in both groups (4% vs 6%), 43% of patients undergoing pancreaticoduodenectomy had an uncomplicate d post-operative course compared with 49% of patients undergoing palliative bypass. The length of surgical procedure and post-operative hospital stay in pancreaticoduodenectomy group were significant longer compared to those patients undergoing palliative bypass (p=0.03 and p=0.02 respectively). The overall actuarial survival was significantly (p<0.01) longer in the group of patients who underwent pancreaticoduodenectomy compared with the group w ith palliative intent surgery. Conclusion: Pancreaticoduodenectomy with cur ative intent for stage III pancreatic cancer patients, could improve progno sis with similar peri-operative morbidity and mortality when compared with palliative bypass.