Vascular Infiltration in Pancreatic Tumor: A Thorny Issue
Matsuno S, Egawa S, Shibuya K, Sunamura M, Takeda K1, Suda K2
1Department of Gastroenterological Surgery, Tohoku University. Sendai, Japan. 2Department of Pathology, Juntendo University. Tokyo, Japan. The Japanese Pancreatic Cancer Registry.
Background and Aim The prognosis of patients with pancreatic cancer is extremely poor due to the difficulty of early diagnosis and complexity of the anatomy. Vascular infiltration is one of the critical issues of the resectability of the tumor and a significant prognostic factor. The data of Japanese Pancreatic Cancer Registry were analyzed to clarify the impact of vascular infiltration toghether with vascular resection on the post-operative survival.
Methods Annual requests for data on pancreatic cancer were issued by Japan Pancreas Society (JPS) from 1981 through 2000 to 350 leading hospitals in Japan. Data on 18,495 patients with pancreatic cancer were submitted using standardized classification by JPS, in which major vascular infiltration is assigned to Stage IVa (locally advanced) or IVb (distant spread). The cumulative survival was analyzed by actuarial method.
Results Through the 20 years of experience, the resection rate for pancreatic cancer increased from 30.3% to 45.1%, since aggressive surgery including major vessel resection was performed in many institutions. However, the median survival of Stage IVa disease is increased from 9 to 12 months. Of 18,495 patients, 5,026 patients with histologically confirmed ductal adenocarcinoma underwent pancreatectomy. The 5-year survival of the patients with Stage IVa disease resected was 11.5%, while that of non-resected Stage IVa disease was 3.4%. Microvascular infiltration was observed even in Stage I disease. Portal vein resection and arterial resection were performed in 653 patients (12.9%) and 113 patients (2.2%) respectively. The survival strongly depended on the extent of the disease including vascular infiltration rather than the resection of large vessels. In the patients with locally advanced Stage IVa disease, the resection of the vessels did not improve the survival even if the extent of vessel infiltration was matched.
Conclusions Vessel resection does not have an additional impact on the survival of the patients although pancreatectomy itself significantly improve the survival of the patients. Novel therapeutic modalities for residual carcinoma after pancreatectomy should be investigated.
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