Recent trends in treatment of TS1 carcinoma of the pancreas

Between July 1974 and June 1994, we resected ductal cell carcinoma of the pancreas in 149 patients. From their formalin‐fixed specimens, we selected those of 19 patients with tumor size (TS)1 pancreatic cancer of, at most, 2 cm in maximum diameter. All the patients had cancer in the head of the pancreas. The chief complaint on presentation at the hospital was jaundice, in 17 of 19, the majority of patients. According to the pTNM, 4 were stage I, 1 was stage II, 13 were stage III, and 1 was stage IV. Thus, the majority of the patients had progressive cancer. Pancreatoduodenectomy was employed in 10 patients, pancreatoduodenectomy with resection of the portal vein in 7, and total pancreatectomy with resection of the portal vein in 2. D2 dissection was performed in all of these patients. Since 1985, intraoperative irradiation has been performed in 5 patients, and since 1986, the continuous administration of 5‐fluorouracil by portal catheterization through the ligamentum teres hepatis has been performed in 6 patients. We compared the pathern of recurrence in the patients treated before 1985 (1974–1984), was intraoperative irradiation was initiated, with that in patients treated in 1985 and later (1985–1994). There were no effects of intraoperative irradiation on local recurrence. The incidence of hepatic metastases was significantly lower in the patients treated by portal catheterization in the latter period. There were four 5‐year survivors; the overall 5‐year survival rate in the 19 patients was 33%, and the mean survival period was 39 months.