Background/Methods: Although the majority of patients with cancer of the body or tail of the pancreas present with advanced disease, in selected patients a DP with curative intent can be performed. We reviewed records of 41 consecutive patients undergoing open or laparoscopic DP with curative intent for pancreatic adenocarcinoma between 2000 and 2007 to determine if surgical resection is useful treatment for such cancers.
Results: Thirty-four open DP, four laparoscopic DP, and three laparoscopic DP converted to open procedures were identified. Extended resection was required in nine patients to achieve adequate surgical margins (22%), including four portal vein resections (10%) and en-bloc resection of additional organs in six (15%). Negative microscopic resection margins were achieved in 33 (80%) patients, and 26 patients (63%) received adjuvant therapy. The overall postoperative complication rate was 54%, with pancreatic fistulas developing in 32%. No deaths occurred during the same hospitalization or within 30 days. Median followup was 8.7 months. Recurrence was documented radiographically in 23 patients (6 local, 17 distant; 56%) with a median disease free interval of 5.6 months (range 0.7-60.3 months). Among the eight patients with positive margins, radiographic evidence of recurrence was found in five (63%) with a median time to progression of 5.1 months. No recurrences were identified in patients resected laparoscopically. Recurrence rates and time to progression were similar between patients receiving standard and extended resections. Local recurrence was identified in six patients (15%) overall, two of whom had positive surgical margins. Median survival was 6.7 months (Kaplan-Meier), and 32% survived greater than one year. Two patients (5%) are 5-year survivors. Survival did not differ significantly between those receiving open and laparoscopic DP. Median survival was improved by adjuvant therapy (8.1 vs. 5.1 months).
Conclusions: These data demonstrate that DP can be performed for pancreatic cancer with low morbidity and may be an effective means of treating or preventing local complications such as obstruction or pain. Moreover, in our limited series, laparoscopic DP does not appear to compromise locoregional control. However, in many patients undetectable micrometastatic disease is present at the time of surgery, leading to early distant recurrence. Improved survival after curative resection is likely to depend upon development of more effective adjuvant chemotherapy and better staging of patients. Use of preoperative neoadjuvant therapy may also help to identify patients likely to develop early distant recurrence.