Survival of cancer of the pancreas. Bases for new strategies in diagnosis and therapy

OBJECTIVE: the ominous prognosis of pancreatic carcinoma (PC) has led to a nihilistic attitude among physicians, and to the need to develop better too ls for diagnosis, staging and treatment. The aim of this study was to analy ze a series of patients with PC in order to determine stage-related surviva l, and to try to improve diagnostic and therapeutic strategies. METHODS: this was a retrospective study of 167 patients diagnosed from 1987 to 1993. The diagnosis was based on cytological pathology findings or on a clinical course compatible with PC. TNM stage and survival were calculated . We also analyzed age, sex, time elapsed until diagnosis, diagnostic tests , size and location, cytologic pathology confirmation, number of patients u ndergoing surgery, and procedures used. RESULTS: age: 67 +/- 12 years, 82 men and 85 women. Time elapsed until diag nosis: 3 +/- 15.7 months. Pathologic diagnosis: 74.8%. Location: head 75%, body 13.9%, tail 7.2%, diffuse 2.4%, not reported 1.2%. Size: 4.6 +/- 2 cm. TNM staging: stage I 13%; stage II 25%; stage III 20%; stage IV 42%. Stage -related survival: stage I 14 months; stage II 6 months; stage III 4 months ; stage IV 1 month. Total survival: 3 months. Surgery was done in 66.5% and resection in 10%; curative surgery in 6.5%; bypass in 81% and diagnostic l aparotomy in 9%. In 55% of the patients surgery revealed a higher stage of disease than had been diagnosed preoperatively. Postoperative mortality was 18%. Survival at 1 and 5 years after curative surgery was 80% and 20%, res pectively. CONCLUSIONS: diagnosis was made at a late stage in many patients. Few patie nts were candidates for radical surgery. Early diagnosis, preoperative stag ing and postoperative management should be improved in these patients, and surgery should be associated with complementary chemotherapy and/or radioth erapy.