Abstracts
2002 Digestive Disease Week

# 107302 Abstract ID: 107302 Is There a Role for Surgery in the Multimodality Treatment of Locally Advanced Pancreatic Carcinoma?
Michael Meyers, John Hoffman, Eric Ross, Neal Meropol, Gary Freedman, Tommy Brown, Burton Eisenberg, Philadelphia, PA

Locally advanced pancreatic cancer carries a poor prognosis and is thought by many to be a contraindication to surgical treatment. Proximity to major vessels precludes surgical resection at most institutions but we believe locally advanced pancreatic carcinoma can effectively be treated surgically as part of a trimodality program. A retrospective review identified 51 patients with involvement of the portal vein or superior mesenteric vein (Ishikawa classification III-V), or those with non-circumferential superior mesenteric or hepatic artery involvement (clinical T4), operated on with curative intent. The average age was 65. Twenty eight patients received preoperative chemoradiation, 19 received postoperative treatment and four received no additional treatment. Nine had previously undergone surgical exploration and felt to be unresectable. Forty-one had Whipple procedures and 10 had total pancreatectomies. Fourteen patients underwent vascular resections with reconstruction. There was one in-hospital death. Overall median survival was 18 months for the entire group. Median survival in those treated preoperatively, those treated postoperatively and those without further treatment was 20, 18 and 6.5 months, respectively (p=.72). One, two and three-year survival rates were 78%, 43% and 29% for the preoperatively treated group and 72%, 47% and 12% for the postoperative therapy group. There was no difference in survival between Ishikawa class III-V. A positive resection margin yielded a median survival of 17 months and a negative margin 25 months (p=.21). Eight patients remain alive with disease, and seven are alive with no evidence of disease. To date, all deaths but one have been from tumor progression. These results suggest there may be a survival benefit in those patients with locally advanced pancreatic cancer treated with surgery as part of a trimodality treatment regimen when compared to previously reported series of patients treated non-operatively reporting survival in the 8-12 month range. However, surgical treatment has not resulted in any long-term cures. We believe aggressive surgical therapy for locally advanced pancreatic cancer should be considered with chemoradiotherapy in appropriately selected patients, with the understanding that long-term cure is unlikely.