The pancreatic cancer is increasing in frequency, generally grows without symptoms until late is its natural course, and presents many discouraging, and unresolved problems in its management. The prognosis of pancreatic cancer is still poor in
spite of
advancement of surgical treatment, parasurgical adjuvant management and improved mortality after the operation.
@ES This paper was based on our experience of 140 cases of pancreatic cancer who underwent operation from 1973 to 1989, and the result were a follows:
@EN 1) The age was distributed from 7 to 84 years, and the most prevalent age group was 6th decases(45%), the next being 7th decades(21%), Male to female sex ratio was 3 : 2.
2) Ninety-one cases of pancreatic cancer were located in the head, 29 in the body & tail. and 20 involved the pancreas diffusely.
3) In relation to tumor location, the most common symptom was jaundice in the head, gastrointestinal symptoms in the body & tail, weight loss in the diffuse type.
4) According to TNM system by the manual of AJCC(1988), 27 cases(19%) were in the stage I, 18(13%) in stage II, 40(28%) in stage III, and 55(40%) in stage IV. Forty-three percent of head cancer was in stage I and II, but both 87% of body & tail
cancer
and diffuse form was in stage III and IV.
5) Forty patients underwent resection of pancreatic cancer-with over-all resectability of 29% The resection rate was 35% in the head, 17% in body & tail, 15% in diffuse form. Pancreatoduodenectomy was performed in 30 cases, regional
pancreatectomy
in
5, distal pancreatectomy in 4 and total pancreatectomy in 1.
6) Resection was impossible in 71%(100/140) of patients. The causes of unresection were locally far-advanced cancer in 51 cases, distant metastasis in 39, poor general condition in 10. Of 100 patients undergoing palliative procedure, biliary
bypass was
done in 39 cases, enteric bypass 13, simultaneous biliary & enteric bypass in 21, and open biopsy only in 27.
7) The most common histopathologic type was ductal cell adenocarcinoma(84%) and the next was undifferentiated carcinoma(6%).
8) The incidence of postoperative complication was 45%(18/40) in resected group, and 20%(20/100) in unresected. Common complications were wound complication, intraabdominal abscess, anastomotic leakage and bleeding etc.
9) Operative mortality rate was 7.5%(3/40) in resected group, and 12%(12/100) in unresected. The causes of death were sepsis, bleeding, hepatic failure, hepatorenal syndrome and aspiration pneumonia.
10) In resected group, follow-up was possible in all patients. One-, 3-, and 5-year survival rate were 35.5%, 23%, and 14% respectively. In unresected group, follow-up was made in 92%(81/88) of patients Six month and 1 year survival rate were
24.6%,
and 11.2%. The average survival were 4.3 months in open biopsy only group and 9.5 months in bypass group.
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