Advances of the surgical management for the pancreatic cancer according to generation

The aim of this study was to evaluate the surgical management for the pancreatic cancer from the point of view of the curability and function. A total of 570 patients who underwent pancreatectomy for invasive ductal adenocarcinoma of the pancreatic head between 1981 and 2010 were reviewed by decade retrospectively. Patients were divided into three groups; first decade (1981-1990, n=172), middle decade (1991-2000, n=194) and last decade (2001-2010, n=204). Patients with severe invasion to the SMA nerve plexuses were included for surgical indication in the first decade, but were excluded for surgical indication in the middle and last decades. Circle dissection of the SMA nerve plexuses was performed in the first decade, but right-side dominant semicircle dissection was performed in the middle and last decades. Prophylactic dissection of the paraaortic lymph nodes (No. 16) was performed in the first and middle decades, but not in the last decade. Stomach preserving procedure was performed in the middle and last decades, but not in the first decade. Intraoperative radiotherapy (IORT) was performed in the first decade and adjuvant chemotherapy was performed in the last decade, but no adjuvant therapy was performed in the middle decade. There was no difference in the prevalence of Stage I/II/III and IVa/IVb between the three groups. Rates of the stomach preserving procedure were 10% in the first decade, 70% in the middle decade and 88% in the last decade. Rates of R0 resection were 47%, 53% and 72%, respectively. Incidence rates of severe diarrhea were 23%, 8%, 5%, and the incidence rates of delayed gastric emptying (DGE) in the patients with stomach-preserving procedure were 29%, 10%, 3%, respectively. Median survival time (MST), 3-year survival rate, 5-year survival rate were 9.4 months, 7.0%, 6.4% in the first decade, 15.4 months, 20.0%, 17.2% in the middle decade and 26.3 months, 40.6%, 33.6% in the last decade. In conclusion, the appropriate surgical indication, R0 resection, stomach preserving procedure and adjuvant chemotherapy could make it possible for good quality of life and long-term survival for patients with pancreatic head cancer.