Adenocarcinoma of the head of the pancreas: Effects of surgical and nonsurgical therapy on survival - A ten-year experience

A retrospective analysis of all patients treated for adenocarcinoma of the head of the pancreas from 1989 to 1998 was performed. Excluded were cancers in the body and tail, cystic neoplasms, ampullary tumors, and cancers of t he duodenum and bile ducts. One hundred forty-five patients were reviewed, and 43 patients underwent pancreaticoduodenectomy. Data collected included the stage, lymph node status, surgical margins, adjuvant therapies, and sur vival. Statistical analysis was performed with Cox's Proportional Hazards A nalysis and Log-Rank Life Table Analysis. The surgical population had a 21 per cent 3-year survival rate and a 7 per cent operative mortality rate. Me dian survival was: 1) the resection group versus no resection was 13.5 vers us 3.1 months; 2) adjuvant therapy versus no therapy after resection was 16 .1 versus 5.1 months; and 3) chemoradiation therapy versus no therapy for u nresectable disease was 5.3 versus 1.8 months. The presence of positive sur gical margins was found in 33 per cent of the surgical specimens and carrie d an increased mortality hazard ratio of 3.1. Patients with negative lymph nodes had a 15 per cent 5-year survival, versus 0 per cent with positive no des. Seventy-three per cent of those resected had a T-2 lesion, and 46 per cent of patients presented with metastatic disease. Surgical resection and adjuvant therapy significantly improves survival in patients with adenocarc inoma of the head of the pancreas. All patients who underwent resection as part of their therapy showed extended survival compared with chemoradiation therapy alone. Adjuvant chemoradiation improved survival when compared wit h surgery alone. Multimodality treatment in carcinoma of the head of the pa ncreas provides the best treatment option. However, better adjuvant therapi es are needed.