Locally Advanced Pancreatic Carcinoma - R 1-2 Resection or Bypass Procedure

Aim: Pancreatic cancer is an aggressive disease with poor prognosis. The radical surgical removal of the tumor (R0 resection) is a major determinant of postoperative survival. The aim of the study is an analysis of postoperative survival in patients with locally advanced pancreatic head carcinoma, where R1-2 pancreaticoduodenectomy or bypass surgery is performed.Materials and Methods: 288 patients with pancreatic head adenocarcinoma have been admitted to the Department of Surgery at the Naval Hospital, Varna for a period from January, 1995 until January, 2016. 115 (39.9%) underwent bypass surgery, and pancreaticoduodenectomy (Whipple or pylorus preserving) in combination with standard lymphadenectomy was performed on the remaining 173 (60.0%). Pancreaticoduodenectomy was defined as R0 resection in 122 (70.5%) patients, R1- in 43 (24.8%) and R2 - in the remaining 8 (4.6%) patients.Results: In the patient groups with R0 and R1 resection, the mean postoperative survival was significantly longer than that after a bypass surgery (18/13 vs 3/7 months) (p<0.001, p=0.023). The survival rate in unresectable, locally advanced pancreatic cancer and bypass surgery is no different from that recorded in patients with R2 resection (7 vs 6 months) (p=0.883). The survival rate in metastatic pancreatic cancer and bypass surgery is significantly shorter compared with that after bypass surgery without the presence of distant metastases (3 vs 7 months) (p=0.002).Conclusion: The main conclusion of the study is that the resection with microscopic residual tumor (R1) is preferable to palliative bypass surgery in cases of locally advanced or borderline resectable pancreatic cancer. Resection with macroscopic residual tumor (R2) should be avoided, as it does not lead to long-term survival. In these cases, bypass surgery is recommended.