[Possibilities and limitations of curative resections in cancers of the pancreas]

Univariate and multivariate analysis was used to assess the potential and limitations of curative resection in cancer of the pancreas. From 1971 to 1993, we operated 466 patients with cancer of the pancreas, using tumor resection in 192 cases. Among these, 40% required resection of the vessels or neighboring organs allowing RO resection in 85% of the patients. The most valuable prognostic factor was curative resection, followed by tumor grading and tumor size. Non-curative tumor resection did not improve survival over exploratory laparotomy or palliative anastomoses. Operative mortality after resection was lower than for procedures leaving the tumor in situ. Extended resection with vessel resection had no effect unless combined with local curative ablation, but cannot be indicated in cases with synchronous metastases or invasion of the neighboring organs. Preoperative explorations do not provide a precise indication of extension in cancer of the pancreas which can only be evaluated in an open procedure by an experienced surgeon.