Pancreatic carcinoma deemed unresectable at exploration may be resected for cure: An institutional experience

Only a minority of patients with a diagnosis of pancreatic adenocarcinoma ( PA) have disease amenable to curative resection, Between April 1987 and Mar ch 1999, 40 patients with pancreatic adenocarcinoma deemed unresectable at exploration at other institutions were considered for neoadjuvant treatment s and then re-evaluated for possible re-exploration. We retrospectively com pared the clinical outcomes, including overall survival (OS), among three g roups: Group A, 22 previously unresectable patients who were subsequently s uccessfully resected, 20 after induction therapy; Group B, 31 patients who received preoperative chemoradiotherapy before their only operation; and Gr oup C, 33 patients who were primarily resected, 27 of whom were then treate d with adjuvant therapy. Of those resectable from Group A, 5 required porta l venorraphy and 3 had hepatic artery reconstruction. Eighteen of the 40 pa tients were unresectable because of progression of disease with a mean OS o f 8 months; 12 were assessed at second laparotomy; 6 were excluded from sec ond operation on the basis of preoperative imaging studies. Kaplan-Meier cu rves showed no differences in OS among the three groups: OS in Group A was 34 months; Group B, 21; and Group C, 13 (P = 0.15). Margin status was compa rable in all three groups (P = 0.52), As expected, nodal positivity was gre atest in Group C (P = 0.001). There were no operative mortalities in Group A, and the morbidity rate was comparable with that of Groups B and C, Upon re-evaluation, many tumors (54%) previously deemed "unresectable" were surg ically extirpated for cure with a median survival comparable with that of p atients who did not undergo previous exploration.