Adenocarcinoma of the Head of the Pancreas: Effects of Surgical and Nonsurgical Therapy

Carr, John Alfred; Ajlouni, Munther
December 1999
American Surgeon;Dec1999, Vol. 65 Issue 12, p1143
Academic Journal
A retrospective analysis of all patients treated for adenocarcinoma of the head of the pancreas from 1989 to 1998 was performed. Excluded were cancers in the body and tail, cystic neoplasms, ampullary tumors, and cancers of the duodenum and bile ducts. One hundred forty-five patients were reviewed, and 43 patients underwent pancreaticoduodenectomy. Data collected included the stage, lymph node status, surgical margins, adjuvant therapies, and survival. Statistical analysis was performed with Cox's Proportional Hazards Analysis and Log-Rank Life Table Analysis. The surgical population had a 21 per cent 3-year survival rate and a 7 per cent operative mortality rate. Median survival was: 1) the resection group versus no resection was 13.5 versus 3.1 months; 2) adjuvant therapy versus no therapy after resection was 16.1 versus 5.1 months; and 3) chemoradiation therapy versus no therapy for unresectable disease was 5.3 versus 1.8 months. The presence of positive surgical margins was found in 33 per cent of the surgical specimens and carried an increased mortality hazard ratio of 3.1. Patients with negative lymph nodes had a 15 per cent 5-year survival, versus 0 per cent with positive nodes. Seventy-three per cent of those resected had a T[sub 2] lesion, and 46 per cent of patients presented with metastatic disease. Surgical resection and adjuvant therapy significantly improves survival in patients with adenocarcinoma of the head of the pancreas. All patients who underwent resection as part of their therapy showed extended survival compared with chemoradiation therapy alone. Adjuvant chemoradiation improved survival when compared with surgery alone. Multimodality treatment in carcinoma of the head of the pancreas provides the best treatment option. However, better adjuvant therapies are needed.


Related Articles

  • Anyone for TAMIS? Watts, E.; Peacock, O.; Gupta, A.; Speake, W.; Lund, J. // Techniques in Coloproctology;Apr2013, Vol. 17 Issue 2, p253 

    The article presents a case study of a 64-year-old woman with adenocarcinoma and who passed through excision of the polyp scar with the use of Trans-Anal Minimally Invasive Surgery (TAMIS).

  • Experiences in Central Pancreatectomy. Chang Moo Kang; Jae-Myeong Lee; Myung Wook Kim; Dong Sub Yoon; Joon Seong Park; Woo Jung Lee // Digestive Surgery;2011, Vol. 28 Issue 1, p57 

    Background: Non-cancerous pancreatic lesions have been increasing, and function-preserving pancreatectomy may be an adequate approach to them. Recent advanced experience of major pancreatectomy has stimulated interest in central pancreatectomy (CP). Materials and Methods: Nineteen patients who...

  • D2 Lymph Node Dissection Improves Staging in Patients with Gastric Adenocarcinoma. PUTCHAKAYALA, KRISHNA; DIFRONZO, L. ANDREW // American Surgeon;Oct2011, Vol. 77 Issue 10, p1326 

    Debate continues over the recommended extent of routine lymphadenectomy for gastric cancer. Although evidence of improved locoregional control with extended dissection accumulates, understaging and stage migration continue to confound the issue. Our objective was to determine whether D2 lymph...

  • Florid Ducts of Luschka Mimicking a Well Differentiated Adenocarcinoma of the Gallbladder: A Case Report. Rajab, Ramzi; Meara, Natalie; Chang, Fuju // Internet Journal of Pediatrics & Neonatology;2007, Vol. 6 Issue 3, p5 

    Ducts of Luschka are small bile ducts located within the gallbladder fossa. They appear to be a normal variant of the biliary anatomy. These ductules may be injured during cholecystectomy leading to bile leak and biliary peritonitis. We report here a cholecystectomy specimen with florid ducts of...

  • Drainage of Recurrent Pleural Effusion Via an Implanted Port and Intrapleural Catheter. Leff, Richard S.; Eisenberg, Burton; Baisden, Clinton E.; Mosley, Katherine R.; Messerschmidt, Gerald L. // Annals of Internal Medicine;Feb86, Vol. 104 Issue 2, p208 

    Reports on a case of a patient with adenocarcinoma of the lung with associated recurrent pleural effusion unresponsive to instillation of tetracycline. Appearance of the disease; Symptoms of the disease; Control of the effusion by placement of a subcutaneous port attached to an intrapleural...

  • Analysis of 5-Year Survivors After a Macroscopic Curative Pancreatectomy for Invasive Ductal Adenocarcinoma. Shimada, Kazuaki; Sakamoto, Yoshihiro; Nara, Satoshi; Esaki, Minoru; Kosuge, Tomoo; Hiraoka, Nobuyoshi // World Journal of Surgery;Aug2010, Vol. 34 Issue 8, p1908 

    Surgical resections for invasive ductal adenocarcinoma of the pancreas can provide the only chance of cure, although the 5-year survivors are not always equated with cure. A total of 229 who underwent a macroscopic curative pancreatectomy for invasive ductal adenocarcinoma between 1990 and 2003...

  • Clinical and pathological features of five-year survivors after pancreatectomy for pancreatic adenocarcinoma. Kenjiro Kimura; Ryosuke Amano; Bunzo Nakata; Sadaaki Yamazoe; Keiichiro Hirata; Akihiro Murata; Kotaro Miura; Kohei Nishio; Toshiki Hirakawa; Masaichi Ohira; Kosei Hirakawa // World Journal of Surgical Oncology;2014, Vol. 12 Issue 1, p1 

    Background Clinical factors determining short-term survival after pancreatectomy have been well studied, but factors predicting long-term survival with curative resection are poorly understood in pancreatic carcinoma. Our objective was to identify clinical and pathological features of five-year...

  • Pancreatic Resection for Side-Branch Intraductal Papillary Mucinous Neoplasm (SB-IPMN): a Contemporary Single-Institution Experience. Dortch, John; Stauffer, John; Asbun, Horacio // Journal of Gastrointestinal Surgery;Sep2015, Vol. 19 Issue 9, p1603 

    Background: Given the malignant potential of main duct intraductal papillary mucinous neoplasm (M-IPMN), surgical resection is generally indicated. With regard to side-branch intraductal papillary mucinous neoplasm (SB-IPMN), resection vs. observation is a topic of debate. Further review of...

  • Urachal tumour: case report of a poorly understood carcinoma.  // World Journal of Surgical Oncology;2009, Vol. 7, p82 

    Background: Urachal carcinoma is an uncommon neoplasm associated with poor prognosis. Case presentation: A 45-year-old man was admitted with complaints of abdominal pain and pollakisuria. A soft mass was palpable under his navel. TC-scan revealed a 11 × 6 cm tumor, which was composed of a...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics