Introduction: Resection is the only hope of cure for patients with pancreatic cancer, though 5-year survival after resection remains dismal. With hope of improving survival, application of adjuvant therapy is intuitively rational. However, adjuvant therapy is applied to a minority of patients after pancreatectomy. The rationale of adjuvant therapy is disconnected from its application. This study was undertaken to assess the data supporting adjuvant therapy following pancreatectomy for adenocarcinoma.
Methods: The National Library of Medicine and the National Institutes of Health were searched for trials of adjuvant therapy after pancreatectomy for adenocarcinoma published since 1980. This search identified 191 trials; 10 were observation-controlled prospective randomized trials. Each trial was graded on its level of data utilizing a National Cancer Institute scale (best score of 1iA to worst score of 3iiiDiii). Methodological deficiencies, including inclusion of other cancers, excluded 7 trials from further review. Meta-analysis was applied to 3 observation-controlled prospective randomized trials of adjuvant therapy. Data collected from the trials included therapies utilized, median survival, 1-year, 2-year, and 5-year survival, and differences in survival by survival curve analysis (Table).Meta-analysis attests that there was not a significant advantage to adjuvant therapy during the first two years after resection, but that a survival advantage did become apparent by five years after resection (odds ratio=2.291, 1.002-5.246, 95% CI).
Results: See Table
Conclusions: There are few observation-controlled prospective randomized trials of adjuvant therapy following pancreatectomy for adenocarcinoma and very few withstand scrutiny. Though very few in numbers, together these trials assert that adjuvant therapy after pancreatectomy for adenocarcinoma improves long-term survival and should be applied. All patients undergoing pancreatectomy for adenocarcinoma should be considered for adjuvant therapy.

Author	Therapy	Grade	# Patients	Median Survival (months)	1-Year Survival	2-Year Survival	5-Year Survival	Survival Curve Difference
GITSG	5FU/XBRT→5FU	1iiA	21	20	63%	42%	19%	p=.03
GITSG	observation		22	11	49%	15%	8%
Klinkenbijl	5 FU/XBRT	1iiA	60	17.1	68%	37%	20%	p=.10
Klinkenbijl	observation		54	12.6	54%	23%	10%
Oettle	Gemcitabine	1iiD	179	22.1	72.5%	48%	23%	p=.06
Oettle	observation		175	20.2	72.5%	42%	12%

Meta-analysis attests that there was not a significant advantage to adjuvant therapy during the first two years after resection, but that a survival advantage did become apparent by five years after resection (odds ratio=2.291, 1.002-5.246, 95% CI).