title: Microscopically incomplete resection offers acceptable palliation in pancreatic cancer.
abstract: BACKGROUND
  Because mortality and morbidity of pancreatic surgery have decreased to acceptable levels, the complex question arises whether pancreatic resection should be performed in patients with preoperatively doubtful resectable pancreatic cancer.
  
  
  METHODS
  Perioperative parameters and outcome of 80 patients who underwent a microscopically incomplete (R1) resection were compared with those of 90 patients who underwent a bypass for locally advanced disease for pancreatic adenocarcinoma. All patients initially underwent exploratory laparotomy with the intention to perform a resection. Quality of life was assessed by analyzing readmissions and their indications.
  
  
  RESULTS
  Groups were similar with respect to age, presenting symptoms, and preoperative health status. Tumors were significantly larger in the bypass group (3.5 cm vs 2.9 cm, P < .01). Hospital mortality was comparable: zero after R1 resection and 2% after bypass. Of all severe complications, only intra-abdominal hemorrhage occurred significantly more frequently after resection (10% vs 2%; P = .03). Hospital stay after resection was significantly longer than after bypass (16 vs 10 days; P < .01). Survival was significantly longer after R1 resection (15.8 vs 9.5 months, P < .01). Sixty-one percent of patients were readmitted for a total of 215 admissions, equally distributed between groups. After R1 resection, 0.58% of the total survival time after initial discharge was spent in the hospital, after bypass, 0.69%, which was not significantly different.
  
  
  CONCLUSIONS
  R1 pancreatic resection and bypass for locally advanced disease can be performed with comparable low mortality and morbidity rates. Readmission rates are also comparable between groups and time spent in the hospital after initial discharge is low. Because resection offers adequate palliation in pancreatic cancer, a more aggressive surgical approach in patients who are found to have a doubtfully resectable tumor could be advocated, even if only an R1 resection can be achieved.
authors.affiliation: Department of Surgery, Academic Medical Center from the University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Koert
authors.initials: K
authors.lastname: Kuhlmann
authors.forename: Steve
authors.initials: S
authors.lastname: de Castro
authors.forename: Tjarda
authors.initials: T
authors.lastname: van Heek
authors.forename: Olivier
authors.initials: O
authors.lastname: Busch
authors.forename: Thomas
authors.initials: T
authors.lastname: van Gulik
authors.forename: Hugo
authors.initials: H
authors.lastname: Obertop
authors.forename: Dirk
authors.initials: D
authors.lastname: Gouma
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome