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Can Pancreatic Resection Cure Pancreatic Cancer?

Patients with pancreatic adenocarcinoma have poor prognoses and pancreatic resection offers the only chance for cure. Researchers at the University of Pennsylvania evaluated survival in 116 consecutive patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy (110) or distal pancreatectomy (6).

Operative mortality was 3 percent, and median survival was 16 months. Survival rates at 1, 3, 5, and 7 years were 60 percent, 23 percent, 19 percent, and 11 percent, respectively. Nine patients survived 5 years. Univariate analysis indicated that lymph node metastases were associated with increased mortality, whereas postoperative adjuvant chemoradiotherapy was associated with survival. In multivariate analysis, adjuvant therapy was the only factor associated with survival (hazards ratio, 0.26; 95 percent CI, 0.15-0.44). Survival rates for patients with negative lymph nodes were 73 percent, 38 percent, 26 percent, and 22 percent at 1, 3, 5, and 7 years, respectively, compared with 52 percent, 14 percent, 14 percent, and 9 percent in patients with positive lymph nodes (P=0.01). Survival rates for patients who received adjuvant therapy were 69 percent, 28 percent, 23 percent, and 18 percent at 1, 3, 5, and 7 years, respectively, compared with 20 percent, 0 percent, 0 percent, and 0 percent for those who did not receive it (P < 0.0001). Male sex, age older than 65, presentation with obstructive jaundice, positive surgical margins, tumor size, and histologic grade were not significantly associated with survival.

Comment: In an accompanying editorial, a physician suggests that surgical cure of pancreatic cancer is a misconception: Pancreatic cancer is a systemic disease by the time it is diagnosed, and it cannot be cured by local therapies such as surgery. Most 5-year survivors ultimately will die from their disease. Adjuvant therapy prolongs survival and therefore may be a therapeutic option for more patients if given preoperatively. True long-term survival after pancreatic resection might become a reality once better systemic therapies are available.

— Stuart Sherman, MD

Published in Journal Watch Gastroenterology December 12, 2001

Citation(s):

Ahmad NA et al. Long term survival after pancreatic resection for pancreatic adenocarcinoma. Am J Gastroenterol 2001 Sep 96 2609-2615.

• Medline abstract (Free)

Tyler D. Adenocarcinoma of the pancreas: Is surgery making a difference? Am J Gastroenterol 2001 Sep 96 2532-2534.

• Medline abstract (Free)

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