Pancreatic cancer--is an aggressive approach justified?
BACKGROUND
Surgery is the only curative treatment for carcinoma of the pancreas. Resection rates can be low (4.5%), figures of 30% have also been suggested as possible. The approach undertaken in this unit is to consider all patients as potentially resectable unless otherwise proven.


METHODS
140 patients were studied over 6-year period; 113 underwent palliative treatment (48% distant metastases, 40% local spread, 11% high operative risk); 14 had a triple bypass (14/113 = 12%), 99 were managed conservatively, 43 received palliative chemotherapy. 23/140 (16%) underwent Whipple's procedure (n = 23; 12 females, 11 males; mean age, 60 years); 4/23 had chronic pancreatitis. Distal pancreatectomy was undertaken in 4 patients.


RESULTS
Median survival time for patients undergoing a triple bypass was 5 months (range, 0.1-20 months), 3 months for patients treated conservatively (range, 0.1-30 months) and 5 months for patients undergoing palliative chemotherapy (range, 1-30 months). 30-day mortality for Whipple's procedure was 4% (1/23) with median survival rate for patients with carcinoma of 13 months (range, 5-66 months); 31 months for patients with clear resection margins and negative nodes (n = 5).


CONCLUSIONS
This policy allows a resection rate of 19% with increased median survival rate for patients with cancer by 8 months more than those who where not resected. Aggressive staging and pancreatic biopsies allow patients to be entered into chemotherapy trials with improvement in survival and potential future benefits.
Krysa
J
J
Department of Surgery, University Hospital Lewisham, London, UK.
Miller
M
M
Kukreja
N
N
Steger
A
A
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy; D016019:Survival Analysis; D016896:Treatment Outcome