Pancreatic ductal adenocarcinoma have very aggressive clinical behavior and poor prognosis. Pancreatic resection with curative intent is possible in a select minority of patients. Recently, several groups have reported improved 5-year survival
rates for
patients undergoing curative resection. This results implicate the importance of patient selection. The authors' experience with 186 consecutive patients at single instition (1988.1~1995.4) with pathologic diagnosis of pancreatic ductal
adenocarcinoma
undergoing operation were reviewed. Mean age of the 186 patients was 58 years (range 29~89), and there were 113 men, 73 women. Tumor location was head in 104 patients (75.3%), body and tail in 41 patients (22%) and diffuse in 5 patient (2.7%).
Resection
was performed in 50 patients and resection rate was 26.9%. Classical pancreaticoduodenectomy was performed in 35, distal pancreatectomy in 15, bypass surgery in 99, laparotomy biopsy and the others in 37 patients. On pathology report, 8 patinets
of
the
resection group had remnant cancer at resection margin. All of the patients wer stratified by stage(I, 9.7%; Ⅱ, 30.1%;Ⅲ, 26.3%;Ⅳ, 30.7%). Operative morbidity was 18.3%, mortality was 2.2%(including 1 intraoperative death), Median survival and
4-year
survival rate of the of the 186 patients was 7 months and 3.4%, respectively. The median survival and 4 year survival rate of 42 patients undergoing curative resections was 12 months and 10%. Of the patients undergoing resection, survival was
greater in
the subset of patients with negative resection margin (p=0.001), but there was no difference in median survival between the positive resection margin group and palliative pypass group. We performed analysis of variates to detect prognostic
factors.
In
univariate analysis, stage,, number of lymph node metastasis and major vessel involvement were significant factors statistically. In multivariate analysis, stage and major vessel involvement were significant. Recent data have reasonable
morbidlty
and
mortality rate and showed prolonged survival in patients undergoing curative resection. We expect rolongation of survival in a select of patients without major vessel involvement through resection with lymph node dissection.
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