Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas

Objective: To evaluate the recent results of pancreatic resection in patients with invasive ductal adenocarcinoma of the pancreas. Design: Retrospective study. Setting: Seventy-seven medical facilities belonging to the Japan Society of Pancreatic Surgery. Patients: One thousand one patients who underwent a resection of the pancreas between January, 1, 1991, and December 31, 1994. Main Outcome Measures: Morbidity and survival after surgery for pancreatic cancer according to the modi fled TNM classification of the International Union Against Cancer. Results: After pancreatic resection, the cumulative postoperative survival rates at 1 and 3 years were 44.5% and 10.3%, respectively. Patients with early-stage cancers had a more prolonged survival time, ie, the cumulative 3-year survival rates for patients with stage I or stage II cancers were 50.4% and 45.5%, respectively; the survival rates for patients with stage III and stage IVa and IVb cancers were 17.6%, 5.7%, and 0%, respectively. The survival rate for patients with N-1 or N-2 metastasis did not differ appreciably, and both groups had significantly better survival rates than patients with N-3 metastasis (P<.001). A significant difference in the postoperative survival time of N-1 metastasis was observed between patients with no lymph node dissection (mean survival, 326.4 days) and patients who received a lymph node dissection (D-1) (mean survival, 478.2 days) (P less than or equal to.01). Canclusions: The recent results of pancreatic resection for invasive ductal adenocarcinoma of the pancreas are generally unsatisfactory. Although the outcome of the patients with an N-1 metastasis can be improved if they receive N-1 lymph node dissection (D-1), an extensive lymph node dissection in advanced cancers does not necessarily produce a favorable prognosis.