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Cancer of the exocrine pancreas. A plea for resection
M Huguier1, H Baumel, J C Manderscheid
1Department of Surgery, Hôpital Tenon, Paris, France.
Background/Aims:
The aim of this retrospective multicentric study was to compare the results of resections with those of surgical palliative procedures.
Material And Methods:
The 3231 patients included had histologically proven adenocarcinoma of the pancreas and were operated on between 1982 and 1988. Seven hundred eighty-seven underwent surgical resection, and 2444 a palliative procedure. Step by step logistic regression was used to determine variables having the greatest impact on post operative mortality. Survivals were compared with the logRank test. A semi parametric Cox model was applied to estimate adjusted relative risk of death.
Results:
After resection and bypass, postoperative mortality was 10% and 15% (P < 0.001), morbidity 35% and 27% (P < 0.001), and mean survival times 19.5 months (SE = 1.1), and 8.8 months (SE = 0.3) (P < 0.001) respectively. In patients without metastases, survival was better after resection than after bypass, even in patients with involvement of lymph nodes adjacent to or distant from the tumor (P = 0.001).
Conclusions:
In spite of the retrospective nature of such comparisons, these results acredit the idea that in patients with pancreatic cancer without metastases, resection should be attempted whenever possible.