Background. Adenosquamous carcinoma of the pancreas is a rare malignancy of the exocrine pancreas. Previous studies and a review of the case reports in the literature have examined the outcomes of patients with this malignancy and have found that survival was short, regardless of whether the patient underwent surgical resection. We report our single-institution experience with adenosquamous carcinoma of the pancreas to determine whether aggressive surgical resection, contrary to previous reports, offers a survival advantage.Patients and Methods. Clinical, operative, and pathologic data were abstracted for consecutive patients diagnosed with adenosquamous pancreatic cancer from 1985 to 2003. Results. For the study period, 25 patients were identified with a diagnosis of adenosquamous carcinoma of the pancreas. Twelve patients underwent curative resection, while 13 patients had either no surgery or palliative bypass. Patients undergoing resection had a mean age of 69 years with 7 of 12 being male. In the nonoperative group, the mean age was 68 years, with 6 of 13 patients being male. In the operative group, procedures included standard pancreatoduodenectomy (PD) in 4 patients, pylorus-preserving PD in 3 patients, distal pancreatectomy in 5 patients. The mean tumor size was 4.5 cm (range, 2.5-9 cm). Morbidity included delayed gastric emptying (4 patients), leaks (2 patients), superficial skin infection, abscess, and GI bleed (1 patient each). There was no operative or in-hospital mortality in the resection group. Five of these patients received adjuvant therapy (5-FU in combination with radiation). The median disease-free time was 8.5 months in the surgical resection group (range, 1.9-20.7), with a median survival of 13.1 (range, 2.9-21.0) months compared to a median survival of 4.8 months (range 0.5-8.9) in the unresected group. Eleven patients died of disease recurrence in the surgical resection group, while one patient was still alive at 17 months after resection. Comparing the twelve patients who underwent resection with the 9 unresected patients with appropriate follow-up there was a significant difference in survival, p<0.001.
Conclusions: Patients with adenosquamous carcinoma have a high recurrence rate and a poor overall prognosis. Aggressive surgical resection does not provide a long-term cure in these patients, however, it may offer a survival advantage.