Are the results of pancreatectomy for pancreatic cancer improving?

Although pancreatectomy is still performed in a few patients with pancreati c cancer, and nearly all patients who develop pancreatic cancer eventually die of their disease, significant improvements have been made recently. Pan createctomy is now safer, with major morbidity (hemorrhage, pancreatic anas tomotic leak, intraabdominal sepsis) occurring in only about 20% and operat ive mortality of less than 5%. Two (seemingly subtle) issues cannot be over emphasized when someone carefully studies the literature: (1) There is a cr ucial difference between actuarial and actual survival, with the former gen erally being higher whereas the latter is true; and (2) careful re-review o f pathologic specimens (especially in long-term survivors) initially diagno sed as pancreatic cancer, preferably by an independent pathologist before p ublishing long-term results is essential. (Erroneous inclusion of patients with nonductal carcinoma substantially and artificially increases survival. ) After curative resection, 5-year actual survival is realistically about 1 0% with median survivals of 12 to 18 months. In certain subgroups with favo rable pathologic characteristics (neoplasms < 2 cm without nodal or perineu ral invasion) the prognosis appears to be significantly better, with the 5- year survival about 20%. The recent improvements in postoperative morbidity and mortality and long-term outcome (resulting also in decreased cost of c are of such patients) have occurred typically in centers with an invested i nterest in and proven record with pancreatic surgery. Further improvements in survival should be sought at the areas of earlier diagnosis and novel tr eatments designed to prevent locoregional recurrences; the role of extended resections must be determined by prospective, randomized trials.