Surgical treatment of pancreatic adenocarcinoma: Taiwan experience

A retrospective study of 155 patients with tissue proven ductal adenocarcinoma of the pancreas treated between January 1981 and December 1991 was performed. Locations of the pancreatic tumors were: pancreatic head in 109 cases (70.3%), head and body or diffusely throughout the gland in 24 patients (15.5%), body and/or tail in another 22 (14.2%). All of the patients were stratified by TNM staging (I, 13.6%; II, 8.4%; III, 34.8%; IV, 43.2%). Twenty-eight patients received pancreatectomies (18.1%), 87 patients had biliary-enteric bypass and/or gastrojejunostomies (56.1%), and another 40 received laparotomies with tumor biopsy only (25.8%). The overall operative mortality of pancreatic cancer surgery was 9.0% with the pancreatectomy, bypass, laparotomy group mortalities at 7.1%, 5.7%, and 17.5% respectively. The risk factors of postoperative mortality were age > or = 70 years, serum albumin 3.0 g% and hemoglobulin < 12.0 g% (p < 0.05). The overall long term survival for pancreatic cancer was: 1y, 17.1%; 2y, 8.5%; 3y, 7.6%; 4y, 5.7%; and 5y, 4.8%; respectively. The mean survival time for the resection group was 23.6M (range 1-108M) with survival rates being: 1y, 42.3%; 2y, 34.6%; 3y, 30.8%; 4y, 23.1%; and 5y, 19.2%; respectively. Stage I cancer and radical resection are two important factors related to long-term survival in patients with pancreatic adenocarcinoma.