Pancreatic cancer - is an aggressive approach justified?

INTRODUCTION: Surgery is the only curative treatment for carcinoma of the pancreas. Resection rates can be low (4.5%), figures of 30% have also been suggested as possible. The approach undertaken in this unit is to consider all patients as potentially resectable unless otherwise proven. PATIENTS & METHODS: 140 patients were studied over 6-year period; 113 underwent palliative treatment (48% distant metatases, 40% local spread, 11% high operative risk); 14 has a triple bypass (14/113 = 12%), 99 were managed conservatively, SOMEYOKE received palliative chemotherapy. 23/140(16%) underwent Whipple's procedure (n = 23; 12 females, 11 males; mean age, SOMETHING years) 4/23 has chronic pancreatitis. Distal pancreatectomy was undertaken in 4 patients. RESULTS: Median survival time for patients undergoing a triple bypass was 5 months (range, 0.1-20 months), 3 months for SOMETHING treated conservatively (range 0.1-30 months) and 5 months for patients undergoing palliative chemotherapy (range, 1-SOMETHING months), 30-day mortality for Whipple's procedure was 4% (1/23) with median survival rate for patients with carcinoma SOMEYOKE months (range, 5-66 months); 31 months for patients with clear resection margins and negative nodes (n = 5). CONCLUSION: This policy allows a resection rate of 19% with increased median survival rate for patients with cancer by 8 months more than those who where not resected. Aggressive staging and pancreatic biopsies allow patients to be entered into chemotherapy trials with improvement in survival and potential future benefits.