title: Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: final results of a randomized multi-institutional trial.
abstract: OBJECTIVE
  Although the outcome of surgery for locally advanced pancreatic cancer remains poor, it is improving, with 5-year survival up to about 10% in Japan. The preliminary results of our multi-institutional randomized controlled trial revealed better survival after surgery than after radiochemotherapy. We report the final results of this study after 5 years of follow-up.
  
  
  METHODS
  Patients with preoperative findings of pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric or common hepatic arteries, or distant metastasis, were included in this randomized controlled trial, with their consent. If the laparotomy findings were consistent with these criteria, the patient was randomized to a surgery group or a radiochemotherapy group (5-fluorouracil 200 mg/m2/day and 5040 Gy radiotherapy). We compared the mean survival time, 3-and 5-year survival rates, and hazard ratio.
  
  
  RESULTS
  The surgery and radiochemotherapy groups comprised 20 and 22 patients, respectively. Patients were followed up for 5 years or longer, or until an event occurred to preclude this. The surgery group had significantly better survival than the radiochemotherapy group (P<0.03). Surgery increased the survival time and 3-year survival rate by an average of 11.8 months and 20%, respectively, and it halved the instantaneous mortality (hazard) rate.
  
  
  CONCLUSIONS
  Locally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection.
authors.affiliation: Department of Surgery, Kyoto University, 54 Shogoinkawaracho, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Doi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Imamura
authors.forename: Ryo
authors.initials: R
authors.lastname: Hosotani
authors.forename: Toshihide
authors.initials: T
authors.lastname: Imaizumi
authors.forename: Takashi
authors.initials: T
authors.lastname: Hatori
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Funakoshi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Wakasugi
authors.forename: Takehide
authors.initials: T
authors.lastname: Asano
authors.forename: Shoichi
authors.initials: S
authors.lastname: Hishinuma
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Makoto
authors.initials: M
authors.lastname: Sunamura
authors.forename: Koji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
authors.forename: Sonshin
authors.initials: S
authors.lastname: Takao
authors.forename: Takashi
authors.initials: T
authors.lastname: Aikou
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Aoki
authors.forename: Akira
authors.initials: A
authors.lastname: Kakita
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ozaki
authors.forename: Satoru
authors.initials: S
authors.lastname: Matsusue
authors.forename: Shunichi
authors.initials: S
authors.lastname: Higashide
authors.forename: Hideki
authors.initials: H
authors.lastname: Noda
authors.forename: Seiyo
authors.initials: S
authors.lastname: Ikeda
authors.forename: Shunzo
authors.initials: S
authors.lastname: Maetani
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D005472:Fluorouracil