title: Long-term outcomes of extended radical resection combined with intraoperative radiation therapy for pancreatic cancer.
abstract: OBJECTIVE
  Systemic and/or local recurrence often occurs even after curative resection for pancreatic cancer (PC). To prevent local relapse we adopted an extended radical resection combined with intraoperative radiation therapy in patients with PC, and all the patients were followed for more than 5 years.
  
  
  METHODS
  We assessed the long-term outcomes of 41 patients who underwent this combined therapy. The cumulative survival curve in this series was depicted using the Kaplan-Meier method. Statistical analyses were performed using the log-rank test.
  
  
  RESULTS
  The actual 5-year survival rate was 14.6%, with a median survival time of 17.6 months. Six patients have been 5-year survivors. Local recurrence occurred in only 2 patients (5.0%). Cancer-related death occurred in 32 patients, 18 of whom had liver metastases. The patients with liver metastases had a significantly shorter survival time than those with other cancer-related causes of death. Patients with n3 lymph node involvement, extrapancreatic nerve plexus invasion, and stage IV disease had significantly poorer prognoses than patients without these characteristics.
  
  
  CONCLUSIONS
  Our combined therapy for patients with PC contributed to local control; however, it provided no survival benefit, because of liver metastases.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Takehisa
authors.initials: T
authors.lastname: Hiraoka
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kanemitsu
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tsuji
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Kei
authors.initials: K
authors.lastname: Horino
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome