Carcinoma of the pancreas: resection outcome at the University Hospital Kuala Lumpur

Abstract

Background: Recent studies have demonstrated a reduction in the morbidity and mortality of pancreatic resection and improvement in the actuarial 5-year survival for patients with resected ductal adenocarcinoma. We reviewed the clinico-pathological characteristics of patients who underwent resection with curative intent for ductal adenocarcinoma of the pancreas between 1980 and 1993.

Methods: Resection with curative intent was performed on 236 of 1368 patients (17%) with pancreatic cancer admitted to the University Hospital Kuala Lumpur, Malaysia. Clinical, demographic, treatment, and pathological variables were analysed. The original pathological report for all cases was reviewed; non-ductal cancers were excluded. The head of the gland was the predominant tumour site (n = 204), followed by the body (n = 18), and tail (n = 14). Seventy-two percent of the patients underwent pancreaticoduodenectomies, 15% underwent total pancreatectomies, 10% underwent distal pancreatectomies, and 3% underwent distal subtotal pancreatectomies.

Results: Operative mortality was 3.4%. Median survival was 14.3 months after resection compared with 4.9 months if patients did not undergo resection (p < 0.0001). Twenty-four patients survived 5 years after surgery (10.2% overall actual 5-year survival rate). Six of the tumours were well differentiated, 10 were moderately differentiated, and 8 were poorly differentiated. Extra-pancreatic invasion occurred in 18 cases (75%), and perineural invasion was present in 20 cases (83%). Ten tumours exhibited invasion of duodenum, ampulla of Vater, and/or common bile duct, and another 2 tumours invaded the portal vein. Lymph node involvement by carcinoma was noted in 10 cases (42%). Twelve patients remain alive without evidence of disease at a median follow-up of 101 months (range, 82-133 months). Ten patients died of recurrent or metastatic pancreatic cancer in a period between 60 and 64 months. Two patients died at 82 and 84 months respectively, of metastatic lung cancer without evidence of recurrent pancreatic disease.

Conclusions: This paper emphasises the grim prognosis of pancreatic ductal adenocarcinoma. Five-year survival cannot be equated to cure. Although pancreatectomy offers the only chance for long-term survival, it should be considered as the best palliative procedure currently available for the majority of patients. This emphasises the need for the development of novel and effective adjuvant therapies for this disease.