Between 1976 and 1991. 6, 301 patients of exocrine pancreatic cancer were operated at the surgical department of the Seoul National University Hospital. To document recent trends of surgical managements of the pancreatic cancer, the patients were
divided into two groups on kthe basis of two different time periods: those operated on from 1976 to 1987(N=202) and those operated on from 1988 to 1991(N=99).
There were no significant differences between the two groups in terms of mean age, sex ratio, symptoms, distribution of pathologic types, location of tumor. During the recent period, stage was upgraded(especially cases of stage 4 was decreased),
and
resection rate of stage 1 was increased(65% vs 100%), and operability(32% vs 45%) and resectability(21% vs 35%) were improved. But causes of these changes were not due to early detection of cancer but due to proper case selection and more active
resection in cases of early stage because there was no significant differences between two groups in terms of symptoms duration before presentation and mean tumor size. General pattern of resection type was not changed, so classic Whipple's
operation(65% vs 60%) was more popular procedure and total pancreatectomy(7% vs 11%) was done only in the specific situations. But in the recent period, regional pancreatectomy was abandoned(4.6% vs 0%) and PPPD was adopted in one case of young
female
patient with papillary cystic carcinoma of the pancreas. Similarly general pattern of bypass was not changed, so biliary bypass was done at 85% and 86% of palliative surgery cases respectively in the two periods and duodenal bypass was done only
in
cases of duodenal obstruction or tumor located in uneinate process at 49% and 52% of palliative surgery cases respectively But in the recent period, external biliary drainage was rarely performed. Operative morbidity(43% vs 23%) and
mortality(6.7%
vs
2%) was markedly decreased. There was no significant difference in survivals between two periods and 5 year survival rates were 11.8% and 6.1% respectively. Factors affecting survival after resection were clinical stage, major vessel invasion and
lymph
node metastasis.
In conclusion pancreatic cancer have very aggressive histologic behavior and poor prognosis and long term suvival can be obtained only through early detection and curative resection of cancer. Operative morbidity mortality and can be minimized
from
proper case selection and case centralization. Some prognostic factors influence on survival after resection and should be considered in selection of operative modalities.
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