Treatment of locally advanced pancreatic cancer: should we resect when resectable?

While the outcome of surgery for locally advanced pancreatic cancer is still quite poor, over the past 2 decades, surgical outcomes have gradually improved in Japan. Because the advantages of surgery over radiochemotherapy have not yet been confirmed by randomized, controlled trials, it has long been discussed whether surgical resection could be indicated for locally advanced pancreatic cancer. We recently performed a multicenter, randomized, controlled trial comparing surgical resection and radiochemotherapy for locally advanced pancreatic cancer. Twenty patients were assigned to the surgery group, and 22 to the radiochemotherapy group. Although there was 1 operative death, surgery offered significantly better results than radiochemotherapy, as measured by 1-year survival (62% vs. 32%, P = 0.05), mean survival time (>17 vs. 11 months, P < 0.03), and hazard ratio (0.46, P = 0.04). There was no significant difference in the quality of life score or laboratory data, apart from increased diarrhea after surgery. In this article, the results of our trial are reviewed in brief, and our opinion on surgical treatment of locally advanced pancreatic cancer is discussed.