Introduction: Surgical resection is the primary treatment of pancreatic adenocarcinoma. Patients with body or tail tumors may have contiguous organ involvement or portal-splenic confluence adherence requiring extended operation to obtain complete gross resection. The aim of this study was to determine survival following contiguous organ or portal vein resection in patients with body or tail adenocarcinoma.
Methods: Between 1983-2000, 513 patients with adenocarcinoma of the body or tail of the pancreas were admitted for treatment and entered into a prospective database. Distal pancreatectomy with or without splenectomy was performed in all resected patients. Patients who had portal vein resection or contiguous organ resection including gastrectomy, adrenalectomy or colectomy were considered to have extended resection. Patients not undergoing pancreatectomy were deemed unresectable either because of metastatic disease (M1) or locally advanced disease (T4) Pathology was reconfirmed in all long term survivors.
Results: Among all patients, 320 had M1 disease and 136 had T4 disease and did not undergo pancreatectomy. Of the 57 (11%) who were resected, extended resection was necessary in 22 (39%) patients; 14 (64%) for contiguous organ involvement and 8 (36%) for portal vein resection. Estimated blood loss, blood transfused and length of hospital stay were significantly more in patients requiring extended resection (p=0.02., p=.01., p=.02 respectively). Median follow-up for patients still alive (n=6) was 84 months (range 40-189 months). Median survival following resection was 15.9 months compared to 5.8 months in patients who were not resected (p<0.0001). Actual 5 and 10-year survival was 19% and 10% following extended resection, 9% and 3% following standard resection, and 0% and 0% if no resection was attempted due to T4 disease.
Conclusion: Patients undergoing extended resection for adenocarcinoma of the pancreatic body or tail have similar long-term survival as those undergoing standard resection, but markedly improved long-term survival compared to those not considered resectable secondary to locally advanced disease. Extended distal pancreatectomy is justified in this group of patients.