Adjuvant therapy following pancreatic resection for pancreatic duct carcinoma: a prospective randomized study.

BACKGROUND/AIMS: This study was made to determine the efficacy of locoregional immunochemotherapy in the treatment of pancreatic ductal carcinoma.

MATERIAL AND METHODS: From November 1991 to June 1996, eighty patients with a diagnosis of pancreatic duct carcinoma underwent pancreatic resection. Patients were divided into two groups, Group A and Group B. Both groups received a standard operative procedure of extended subtotal pancreatectomy with regional lymphadenectomy of the celiac axis, the hepatoduodenal ligament and the superior mesenteric vessels. However, Group B patients had two arterial catheters implanted at the end of the operative procedure: one via the splenic artery, after its ligation near the origin at the celiac axis and directed towards the spleen; the second catheter was implanted into a side arterial branch of the middle colic artery into the superior mesenteric artery.

RESULTS: Group B patients have a significantly greater survival (30 months) compared to Group A patients (16.8 months). The proportion of alive patients between both Groups is much higher for Group's B patients (92% versus 55%). Grading of the tumor, size of the tumor, and presence of positive lymph nodes were seen to be very important factors affecting overall survival in Group A patients, but not in Group B patients. It is impressive that from 25 Group A patients with lymph node involvement, only 8 are presently alive versus 25 alive of 28 total Group B patients with positive lymph nodes.

CONCLUSION: Locoregional immunochemotherapy as an adjuvant modality following pancreatic resection offers impressive advantages in terms of survival regardless of stage, lymph involvement, and tumor size. This therapy deserves further attention and consideration in the treatment of Pancreatic Duct Carcinoma.