Cancer of the exocrine pancreas. A plea for resection.
OBJECTIVE
The aim of this retrospective multicentric study was to compare the results of resections with those of surgical palliative procedures.


METHODS
The 3231 patients included had histologically proven adenocarcinoma of the pancreas and were operated on between 1982 and 1988. Seven hundred eighty-seven underwent surgical resection, and 2444 a palliative procedure. Step by step logistic regression was used to determine variables having the greatest impact on post operative mortality. Survivals were compared with the logRank test. A semi parametric Cox model was applied to estimate adjusted relative risk of death.


RESULTS
After resection and bypass, postoperative mortality was 10% and 15% (P < 0.001), morbidity 35% and 27% (P < 0.001), and mean survival times 19.5 months (SE = 1.1), and 8.8 months (SE = 0.3) (P < 0.001) respectively. In patients without metastases, survival was better after resection than after bypass, even in patients with involvement of lymph nodes adjacent to or distant from the tumor (P = 0.001).


CONCLUSIONS
In spite of the retrospective nature of such comparisons, these results acredit the idea that in patients with pancreatic cancer without metastases, resection should be attempted whenever possible.
Huguier
M
M
Department of Surgery, Hôpital Tenon, Paris, France.
Baumel
H
H
Manderscheid
J C
JC
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate