Palliative surgery for pancreatic carcinoma. Results from a 7-year period

Introduction: High perioperative complication rates in the 1980s led to pre ferred use of endoscopic therapy for surgical palliation of pancreatic canc er. This encouraged us to analyse our own patients retrospectively. Materia l and methods: In the period from 1 January 1992 to 31 December 1998, 253 p atients with an exocrine carcinoma of the pancreas were operated on at the St. Elisabeth Hospital Cologne-Hohenlind: 73 patients (28.9%) underwent cur ative resection (RO) while 180 patients (71.1%) had palliative operative tr eatment (R1/R2). Palliative resection was performed in 22 patients (8.7%). Intestinal bypass surgery was done in 113 patients (44.7%) as a gastrojejun ostomy and in 16 patients (6.3%) as a duodenojejunostomy. A biliodigestive anastomosis was performed in 85 patients (33.6%). This procedure was combin ed with a gastroenterostomy in 78 patients (30.8%). In 18 patients (7.1%) n o surgical palliation was possible and the operation finished as a diagnost ic laparotomy. Results: The overall mortality rate within the first 30 (60) days was 5.5% (12.7%). Patients whose carcinoma had been resected curative ly had a 30 (60)-day mortality rate of 2.7% (4.1%), compared to a rate in p alliatively treated patients (resection/bypass/probatoria) of 6.7% (16.1%). Patients with palliatively resected tumor had perioperative mortality of 4 .5% (4.5%), whereas patients who did not undego resection had 6.9% (17.7%). The survival rate for curatively resected patients after Kaplan-Meier extr apolation was 64.7% after 1 year and 31.2% and 26.2% after 3 and 5 years, w ith a median survival time of 552 days. Palliatively operated patients had a survival rate of 19.4%, 2.5% and 0% for 1, 3 and 5 years. Median survival time was 171 days in this situation. Compared to patients without resectio n (17.4% and 2.0%), patients with palliative resection had survival rates f or 1 and 3 years of 40% and 5.9%. After 5 years none of these patients were alive. Conclusions: Our data show a high success of surgical palliation in pancreatic cancer in centers with a high frequency of pancreatic surgery P atients that could not be cured (R1/R2), although undergoing extensive proc edures, had better survival rates than patients treated with bypass surgery . Perioperative mortality rate was comparatively low This justifies aggress ive surgical management of pancreatic carcinoma.