Objective: The benefit of radical surgical resection of contiguously involved structures for locally advanced pancreatic cancer is not known. The aim of this study was to examine patient outcome after extended pancreatic resection for locally advanced cancer of the pancreas.
Methods: We retrospectively reviewed the records of 116 patients with adenocarcinoma of the pancreas who underwent extirpative pancreatic surgery between 1987 and 2000. Of the 116 patients, 39 (34%) required resection of surrounding structures (Group I), and 77 patients (64%) had standard pancreatic resections (Group II). In all cases, all macroscopic disease was excised. In Group I, a total of 43 contiguously involved structures were resected; vascular 25 (58%), colon 12 (28%), adrenal 3 (7%), liver 2 (5%), stomach 1 (2%), and multiple 3 (7%). Excision of regional blood vessels included: superior mesenteric vein and/or portal vein in 16, hepatic artery in 5, celiac axis in 4, and middle colic vessels in 3.
Results: No difference between Group I and Group II was detected for the following parameters: age, sex, history of previous operation, estimated blood loss, or hospital stay. For the entire cohort, the morbidity and mortality were 40% and 1.7%, respectively, and were similar between the two groups. Adjuvant therapy was administered to over 90% of patients in both groups. However, patients in Group I were more likely to have received neoadjuvant therapy (74% vs. 42% (p=.001)). Total pancreatectomy and distal pancreatectomy were more often performed in Group I (p=.003). Additionally, the mean operative time was longer (8.3 hours compared to 7 hours (p=.0006)). Both groups had similar rates of microscopic positive margins and involved lymph nodes, as well as total number of lymph nodes removed. The median survival for patients in Group I was 24 months and in Group II was 17 months (p=.28). In comparing patients in Group I who had vascular resections vs. colon resections, the median survival was 26 and 16 months, respectively (p=.06).
Conclusion: We were unable to detect a difference in outcome for patients with locally advanced cancers requiring extended pancreatic resections compared to patients with standard resections. Although not statistically significant, patients with vascular structures resected had a longer median survival than patients requiring colon resections. En bloc resection of involved surrounding structures, to completely extirpate all macroscopic disease, may be of benefit in selected patients with locally advanced disease.
