TITLE:
Stage II Pancreatic Cancer: Radical, Palliative Surgery or Stenting?
AUTHORS:
Audrius Šileikis, Benediktas Kurlinkus, Marius Kryžauskas, Kęstutis Strupas
KEYWORDS:
Pancreatic Ductal Adenocarcinoma, Radical Surgery, Palliative Surgery, Biliary Tract Stenting
JOURNAL NAME:
Surgical Science,
Vol.6 No.12,
December
29,
2015
ABSTRACT: Background: Pancreatic ductal adenocarcinoma is the
fourth most common reason of death among oncological diseases with ever increasing mortality. At the time of
diagnosis, patients are usually suitable for three ways of treatment: radical,
palliative surgery or stenting. Deciding the best option depends on clinical
situation, but is still a matter of debate. Methods: We performed a retrospective
research of patients with stage II pancreatic head cancer treated in our clinic
between years 2002-2014. Four groups were formed according to the used
treatment method: group A: radical surgery with R0 (microscopic tumour
clearance) margin; group B: radical surgery with R1 (presence of tumour cells
within 1 mm of the resection margin) margin; group C: biliary tract stenting;
group D: biliodigestive anastomosis. Clinical data and most importantly the
survival of these patients were compared. Results: 200 patients were involved
in the final analysis, 82 (41%) of them were IIA and 118 (59%) were IIB. Group
A consisted of 113 patients; group B consisted of 28 patients; group C
consisted of 33 patients; group D consisted of 26 patients. In patients with
IIA stage, group A had the highest survival rate compared with other groups,
mean survival was 3.242 versus 1.600; 0.454; 0.652 years. Patients with IIB
stage of cancer similarly had longer survival in group A versus other groups,
1.720 versus 0.931; 0.713; 0.957 years. Conclusions: Patients with IIA and IIB
stage of pancreatic cancer benefit the most from radical surgery with R0
margin. However, for patients with lymph node involvement (stage IIB) and when
achieving R0 margin is hardly possible, neoadjuvant treatment seems promising,
but we need further randomized controlled trials to fully confirm its
effectiveness.