[Treatment of pancreatic adenocarcinoma].
Better results of resections for pancreatic adenocarcinoma are reported in published data from 1990: 1. the lower mortality rate is probably not the only reason why these results are better; 2. the palliative resections rate seem to be lower (as the rates of exploratory laparotomies and by-pass procedures); 3. the impact of resection's quality on the results is difficult to demonstrate and the benefit of extended lymphadenectomy remains unclear; 4. moreover, in recent published series, many patients had adjuvant or neoadjuvant therapy, but often in uncontrolled studies. Multimodality treatment is probably useful for better local control and better disease free survival; this therapeutic approach is widely used today but the results remain to be confirmed by clinical trials. Unfortunately, 90% of the patients had locally advanced or metastatic disease at the time of diagnosis; in these patients clinical research is a challenge in order to change the prognosis; actually, epidemiological studies are still showing that quite all the patients die.
Delpero
Jean-Robert
JR
Département de chirurgie, Institut Paoli-Calmettes 13273 Marseille. jrdelpero@wanadoo.fr
Giovannini
Marc
M
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007813:Laparotomy; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis