Surgery Today

, Volume 38, Issue 11, pp 1021–1028

Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: Final results of a randomized multi-institutional trial

  • Ryuichiro Doi
  • Masayuki Imamura
  • Ryo Hosotani
  • Toshihide Imaizumi
  • Takashi Hatori
  • Ken Takasaki
  • Akihiro Funakoshi
  • Hideyuki Wakasugi
  • Takehide Asano
  • Shoichi Hishinuma
  • Yoshiro Ogata
  • Makoto Sunamura
  • Koji Yamaguchi
  • Masao Tanaka
  • Sonshin Takao
  • Takashi Aikou
  • Koichi Hirata
  • Hiroyuki Maguchi
  • Koichi Aiura
  • Tatsuya Aoki
  • Akira Kakita
  • Makoto Sasaki
  • Masahiko Ozaki
  • Satoru Matsusue
  • Shunichi Higashide
  • Hideki Noda
  • Seiyo Ikeda
  • Shunzo Maetani
  • Shigeaki Yoshida
  • The Japan Pancreatic Cancer Study Group
Original Article

Abstract

Purpose

Although the outcome of surgery for locally advanced pancreatic cancer remains poor, it is improving, with 5-year survival up to about 10% in Japan. The preliminary results of our multi-institutional randomized controlled trial revealed better survival after surgery than after radiochemotherapy. We report the final results of this study after 5 years of follow-up.

Methods

Patients with preoperative findings of pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric or common hepatic arteries, or distant metastasis, were included in this randomized controlled trial, with their consent. If the laparotomy findings were consistent with these criteria, the patient was randomized to a surgery group or a radiochemotherapy group (5-fluorouracil 200 mg/m2/day and 5040 Gy radiotherapy). We compared the mean survival time, 3-and 5-year survival rates, and hazard ratio.

Results

The surgery and radiochemotherapy groups comprised 20 and 22 patients, respectively. Patients were followed up for 5 years or longer, or until an event occurred to preclude this. The surgery group had significantly better survival than the radiochemotherapy group (P < 0.03). Surgery increased the survival time and 3-year survival rate by an average of 11.8 months and 20%, respectively, and it halved the instantaneous mortality (hazard) rate.

Conclusion

Locally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection.

Key words

Pancreatic cancer Local invasion Radiochemotherapy Randomized multi-institutional trial Laparotomy Long-term survival 

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Copyright information

© Springer 2008

Authors and Affiliations

  • Ryuichiro Doi
    • 1
  • Masayuki Imamura
    • 1
  • Ryo Hosotani
    • 1
  • Toshihide Imaizumi
    • 2
  • Takashi Hatori
    • 2
  • Ken Takasaki
    • 2
  • Akihiro Funakoshi
    • 3
  • Hideyuki Wakasugi
    • 3
  • Takehide Asano
    • 4
  • Shoichi Hishinuma
    • 5
  • Yoshiro Ogata
    • 5
  • Makoto Sunamura
    • 6
  • Koji Yamaguchi
    • 7
  • Masao Tanaka
    • 7
  • Sonshin Takao
    • 8
  • Takashi Aikou
    • 8
  • Koichi Hirata
    • 9
  • Hiroyuki Maguchi
    • 10
  • Koichi Aiura
    • 11
  • Tatsuya Aoki
    • 12
  • Akira Kakita
    • 13
  • Makoto Sasaki
    • 14
  • Masahiko Ozaki
    • 15
  • Satoru Matsusue
    • 16
  • Shunichi Higashide
    • 17
  • Hideki Noda
    • 17
  • Seiyo Ikeda
    • 18
  • Shunzo Maetani
    • 19
  • Shigeaki Yoshida
    • 20
  • The Japan Pancreatic Cancer Study Group
  1. 1.Department of SurgeryKyoto UniversityKyotoJapan
  2. 2.Department of Gastroenterological SurgeryTokyo Women’s Medical UniversityTokyoJapan
  3. 3.Department of GastroenterologyNational Kyushu Cancer CenterFukuokaJapan
  4. 4.Second Department of SurgeryChiba UniversityChibaJapan
  5. 5.Department of SurgeryTochigi Cancer CenterUtsunomiya, TochigiJapan
  6. 6.First Department of SurgeryTohoku University School of MedicineSendaiJapan
  7. 7.Department of Surgery and OncologyKyushu UniversityFukuokaJapan
  8. 8.Department of Surgical Oncology and Digestive SurgeryKagoshima UniversityKagoshimaJapan
  9. 9.First Department of SurgerySapporo Medical UniversitySapporoJapan
  10. 10.Center for GastroenterologyTeine Keijinkai HospitalSapporoJapan
  11. 11.Department of SurgeryKeio UniversityTokyoJapan
  12. 12.Department of SurgeryTokyo Medical CollegeTokyoJapan
  13. 13.Department of SurgeryKitasato UniversityKanagawaJapan
  14. 14.Department of SurgeryNational Nagasaki Medical CenterNagasakiJapan
  15. 15.Department of General SurgeryYokohama Rousai HospitalYokohamaJapan
  16. 16.Department of Abdominal SurgeryTenri HospitalNaraJapan
  17. 17.Department of SurgeryNagahama City HospitalNagahamaJapan
  18. 18.First Department of SurgeryFukuoka UniversityFukuokaJapan
  19. 19.Tenri Institute of Medical ResearchNaraJapan
  20. 20.National Cancer Center Hospital EastChibaJapan

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