Results of 1001 Pancreatic Resections for Invasive Ductal Adenocarcinoma of the Pancreas

Koichi Hirata, MD; Takashi Sato, MD; Mitsuhiro Mukaiya, MD; Kazuhiro Yamashiro, MD; Masami Kimura, MD; Kazuaki Sasaki, MD; Ryuichi Denno, MD
Arch Surg. 1997;132(7):771-776. doi:10.1001/archsurg.1997.01430310085018.
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Objective:  To evaluate the recent results of pancreatic resection in patients with invasive ductal adenocarcinoma of the pancreas.

Design:  Retrospective study.

Setting:  Seventy-seven medical facilities belonging to the Japan Society of Pancreatic Surgery.

Patients:  One thousand one patients who underwent a resection of the pancreas between January, 1, 1991,and December 31, 1994.

Main Outcome Measures:  Morbidity and survival after surgery for pancreatic cancer according to the modified TNM classification of the International Union Against Cancer.

Results:  After pancreatic resection, the cumulative postoperative survival rates at 1 and 3 years were 44.5% and 10.3%, respectively. Patients with early-stage cancers had a more prolonged survival time, ie, the cumulative 3-year survival rates for patients with stage I or stage II cancers were 50.4% and 45.5%, respectively; the survival rates for patients with stage III and stage IVa and IVb cancers were 17.6%, 5.7%, and 0%, respectively. The survival rate for patients with N1 or N2 metastasis did not differ appreciably, and both groups had significantly better survival rates than patients with N3 metastasis (P<.001). A significant difference in the postoperative survival time of N1 metastasis was observed between patients with no lymph node dissection (mean survival, 326.4 days) and patients who received a lymph node dissection (D1) (mean survival, 478.2 days) (P≤.01).

Conclusions:  The recent results of pancreatic resection for invasive ductal adenocarcinoma of the pancreas are generally unsatisfactory. Although the outcome of the patients with an N1 metastasis can be improved if they receive N1 lymph node dissection (D1), an extensive lymph node dissection in advanced cancers does not necessarily produce a favorable prognosis.Arch Surg. 1997;132:771-776


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