The Long-Term Survival of Patients with Ductal Carcinoma of the Pancreatic Head and Body

Seventy-six patients with ductal carcinoma of the pancreatic head and body who underwent resection during the past 20 years were studied. Included were 1 patient in stage I, 5 patients in stage II, 27 patients in stage III, 24 patients in stage IVa, and 19 patients in stage IVb. Curative resection was achieved in 100% of the patients with stage I and II, 81.5% of stage III, 41.7% of stage IVa, and 10.5% of stage IVb. The surgical procedure involved pancreatoduodenectomy or total pancreatectomy with extensive skeletonization. Intraoperative radiotherapy and perioperative chemotherapy were seldom performed. Surgical mortality (deaths within 3 months after surgery) decreased from 19.4% before 1986 to 2.5% after 1987. There were 11 (18.6%) long-term survivors of more than 3 years among 59 patients and 7 (15.2%) survivors of more than 5 years among 46 patients. These long-term survivors were all found in the group that underwent pathologically curative resection, and there were no long-term survivors among patients with pathologically noncurative resection. In the group receiving curative resection, 28.9% (11/38) of patients survived more than 3 years and 24.1% (7/29) of patients survived more than 5 years. The 3-year-survival rates were 60% in stages I and II, 26.9% in stage III, 4.2% in stage IVa, and none in stage IVb; the 5-year-survival rates were 40% in stages I and II, 19.2% in stage III, and none in stage IV. Curative resection should be applied to patients with stages I, II, III, and IVa tumors, and excessive surgery should be avoided for patients with stage IVb.