Pancreatic cancer with distant metastases: a contraindication for radical surgery?
OBJECTIVE
The purpose of this study was to analyze cases of resected pancreatic cancer with distant metastasis (M1) and to review the surgical indication for these patients.


METHODS
Between July 1981 and December 2007, 542 patients with pancreatic cancer underwent surgery at the Department of Surgery II, Nagoya University. These patients included 48 cases of paraaortic lymph node metastases, 11 cases of hepatic metastases and 6 cases of peritoneal metastases. The overall survival rates were evaluated using the Kaplan-Meier method.


RESULTS
Overall survival in patients stratified by M0 and M1 showed significant differences between M0 and M1 cases. As for hepatic metastases and peritoneal metastases, no significant difference in survival was observed between resected and unresected cases. However, survival in cases of paraaortic lymph node metastases was better than that in unresected cases, although this observation was not statistically significant.


CONCLUSIONS
Hepatic or peritoneal metastases are contraindications for radical surgery for pancreatic cancer. On the other hand, patients with paraaortic lymph node metastases are relatively promising targets for radical surgery, and radical resection with extended lymphadenectomy remain an option for these patients.
Yamada
Suguru
S
Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Fujii
Tsutomu
T
Sugimoto
Hiroyuki
H
Kanazumi
Naohito
N
Kasuya
Hideki
H
Nomoto
Shuji
S
Takeda
Shin
S
Kodera
Yasuhiro
Y
Nakao
Akimasa
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate