Clinical results of extended lymphadenectomy and intraoperative radiotherapy for pancreatic adenocarcinoma.
OBJECTIVE
The efficacy of extended lymphadenectomy and intraoperative radiotherapy for resectable pancreatic cancer is controversial. The objective of this study was to clarify the surgical outcome after pancreatic resection with extended lymphadenectomy or intraoperative radiotherapy in patients with pancreatic adenocarcinoma.


METHODS
Between 1992 and 2002, 105 patients with pancreatic adenocarcinoma undergoing surgical resection were retrospectively analyzed. Eighty-eight patients had invasive ductal adenocarcinoma and 17 had invasive intraductal papillary mucinous adenocarcinoma. Seventy-six patients underwent pancreatic resection with extended lymphadenectomy and 44 received 20 Gy intraoperative radiotherapy.


RESULTS
Patients with invasive intraductal papillary mucinous adenocarcinoma had a similar prognosis to those with invasive ductal adenocarcinoma. There was no significant difference in survival (p = 0.86) between patients with and without extended lymphadenectomy. There was no significant difference in survival (p = 0.053) between patients with and without intraoperative radiotherapy. Patients without lymph node metastasis had a significantly better prognosis (p = 0.0015) than those with nodal involvement.


CONCLUSIONS
Neither extended lymphadenectomy nor intraoperative radiotherapy showed a survival advantage in patients with resectable pancreatic adenocarcinoma. Pancreatic cancer patients without nodal involvement had a significantly better prognosis than those with nodal involvement.
Nakagohri
Toshio
T
Department of Surgery, National Cancer Center Hospital East, Kashiwa, Japan. tnakagor@east.ncc.go.jp
Kinoshita
Taira
T
Konishi
Masaru
M
Takahashi
Shinichiro
S
Tanizawa
Yutaka
Y
D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate