Surgical Treatment for Advanced Cancer of the Pancreas

Takehisa Hiraoka

First Department of Surgery, Kumamoto University School of Medicine

The prognosis for patients with resectable pancreatic cancer has consistently been poor. Since 1984, extended resection combined with intraoperative radiotherapy (IORT) has been performed on 35 patients to prevent local recurrence in our institution. Following extended resection, a dose of 30 Gy of 9-12 MeV electrons was delivered to the dissected field including the paraaortic area from the diaphragm above to the inferior mesenteric artery below. The 5-year survival rate was 16.8% for all 35 patients, 22.3% for patients who had macroscopic tumor clearance and 18.9% for patients with a stage IVa tumor according to the Japanese ciassification. Patients with a stage IVb tumor died within one year. In autopsies of 10 patients who underwent the combined therapy, 4 were found to have local recurrent tumor cells enclosed by thick, firm connective tissue. There was no local recurrence in 2 patients who underwent noncurative resection. Enhanced local control induced by the combined therapy, however, has only a limited impact on overall survival because of hepatic metastasis. These results suggest that a combination of IORT and extended resection is not indicated for patients with far advanced cancer and should be performed only on selected patients to control local recurrence. Anticancer treatment for metastases of the liver must be established as soon as possible to cure pancreatic cancer.

Key words
pancreatic cancer, extended resection, intraoperative radiotherapy

Reprint requests
Takehisa Hiraoka First Department of Surgery, Kumamoto University School of Medicine
1-1-1 Honjo, Kumamoto, 850 JAPAN

Accepted
May 21, 1997

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