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R2 resection in pancreatic cancer—does it make sense?

Langenbeck's Archives of Surgery volume 393, pages 929–934 (2008)Cite this article

Abstract

Background

The goal of surgical treatment in patients with pancreatic cancer is the complete resection of tumor tissue; however, the intraoperative appraisal of resectability can be difficult. Extensive surgical exploration for definitive clear resectability may lead to R2 resections in single cases.

Patients

We analyzed 38 patients with pancreatic cancer with remaining macroscopic tumor tissue after pancreatic resection, as R0 resection was not possible. Patients were compared to 46 patients with unresectable cancer without distant metastases or peritoneal carcinomatosis, in which a bypass procedure was performed.

Results

Operating time and hospital stay were significantly longer after R2 resection. Intraoperative blood loss was significantly higher; and severe surgical complications and the need for relaparotomy were significantly more frequent after R2 resection. The 30-day mortality rate was higher after R2 resection; this difference was not statistically significant. Median survival was comparable in both groups. Two years after surgery, 22.6% of the patients after R2 resection were still alive compared to 10.9% after bypass surgery.

Conclusion

Tumor debulking is not a treatment option in patients with advanced pancreatic cancer, but the patient is not at a disadvantage compared to bypass procedures if tumor tissue remains and R0 resection cannot be achieved after surgical exploration.

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References

  1. Warshaw AL, Swanson RS (1988) Pancreatic cancer in 1988. Possibilities and probabilities. Ann Surg 208:541–553

    PubMed  Article  CAS  Google Scholar 

  2. Gudjonsson B (1987) Cancer of the pancreas. 50 years of surgery. Cancer 60:2284–2303

    PubMed  Article  CAS  Google Scholar 

  3. Mosca F, Giulianotti PC, Balestracci T, Di CG, Pietrabissa A, Sbrana F, Rossi G (1997) Long-term survival in pancreatic cancer: pylorus-preserving versus Whipple pancreatoduodenectomy. Surgery 122:553–566

    PubMed  Article  CAS  Google Scholar 

  4. Warshaw AL, Fernandez-del CC (1992) Pancreatic carcinoma. N Engl J Med 326:455–465

    PubMed  CAS  Article  Google Scholar 

  5. Yeo CJ (1998) Pancreatic cancer: 1998 update. J Am Coll Surg 187:429–442

    PubMed  CAS  Google Scholar 

  6. Kuhlmann K, de CS, van HT, Busch O, van GT, Obertop H, Gouma D (2006) Microscopically incomplete resection offers acceptable palliation in pancreatic cancer. Surgery 139:188–196

    PubMed  Article  Google Scholar 

  7. Spanknebel K, Conlfson KC (2001) Advances in the surgical management of pancreatic cancer. Cancer J 7:312–323

    PubMed  CAS  Google Scholar 

  8. Koninger J, Giese T, di Mola FF, Wente MN, Esposito I, Bachem MG, Giese NA, Buchler MW, Friess H (2004) Pancreatic tumor cells influence the composition of the extracellular matrix. Biochem Biophys Res Commun 322:943–949

    PubMed  Article  CAS  Google Scholar 

  9. Chao C, Hoffman JP, Ross EA, Torosian MH, Eisenberg BL (2000) Pancreatic carcinoma deemed unresectable at exploration may be resected for cure: an institutional experience. Am Surg 66:378–385

    PubMed  CAS  Google Scholar 

  10. Johnstone PA, Sindelar WF (1996) Radical reoperation for advanced pancreatic carcinoma. J Surg Oncol 61:7–11

    PubMed  Article  CAS  Google Scholar 

  11. Mann O, Strate T, Schneider C, Yekebas EF, Izbicki JR (2006) Surgery for advanced and metastatic pancreatic cancer—current state and perspectives. Anticancer Res 26:681–686

    PubMed  Google Scholar 

  12. Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93:1232–1237

    PubMed  Article  CAS  Google Scholar 

  13. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW (2004) Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 91:586–594

    PubMed  Article  CAS  Google Scholar 

  14. Muller MW, Friess H, Koninger J, Wente MN, Martin D, Hinz U, Ceyhan GO, Blaha P, Kleeff J, Buchler MW (2008) Factors influencing survival after bypass procedures in patients with advanced pancreatic adenocarcinomas. Am J Surg 195(2):221–228

    PubMed  Article  Google Scholar 

  15. Schmidt J, Welsch T, Jager D, Muhlradt PF, Buchler MW, Marten A (2007) Intratumoural injection of the toll-like receptor-2/6 agonist ‘macrophage-activating lipopeptide-2’ in patients with pancreatic carcinoma: a phase I/II trial. Br J Cancer 97:598–604

    PubMed  Article  CAS  Google Scholar 

  16. Gouma DJ, Nieveen van Dijkum EJ, van Geenen RC, van Gulik TM, Obertop H (1999) Are there indications for palliative resection in pancreatic cancer? World J Surg 23:954–959

    PubMed  Article  CAS  Google Scholar 

  17. Truty MJ, Urrutia R (2007) Transforming growth factor-beta: what every pancreatic surgeon should know. Surgery 141:1–6

    PubMed  Article  Google Scholar 

  18. Lillemoe KD, Cameron JL, Yeo CJ, Sohn TA, Nakeeb A, Sauter PK, Hruban RH, Abrams RA, Pitt HA (1996) Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer? Ann Surg 223:718–725

    PubMed  Article  CAS  Google Scholar 

  19. Reinders ME, Allema JH, van Gulik TM, Karsten TM, de Wit LT, Verbeek PC, Rauws EJ, Gouma DJ (1995) Outcome of microscopically nonradical, subtotal pancreaticoduodenectomy (Whipple’s resection) for treatment of pancreatic head tumors. World J Surg 19:410–414

    PubMed  Article  CAS  Google Scholar 

  20. Huguier M, Baumel H, Manderscheid JC (1996) Cancer of the exocrine pancreas. A plea for resection. Hepatogastroenterology 43:721–729

    PubMed  CAS  Google Scholar 

  21. Nieveen van Dijkum EJ, Kuhlmann KF, Terwee CB, Obertop H, de Haes JC, Gouma DJ (2005) Quality of life after curative or palliative surgical treatment of pancreatic and periampullary carcinoma. Br J Surg 92:471–477

    PubMed  Article  CAS  Google Scholar 

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Acknowledgement

The authors thank Michelle Bhairo for editing the manuscript.

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Author notes

  1. Michael W. Müller & Helmut Friess

    Present address: Department of Surgery, Technische Universität, Munich, Germany

Affiliations

  1. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Jörg Köninger, Moritz N. Wente, Beat P. Müller-Stich, Francesco F. di Mola, Carsten N. Gutt, Ulf Hinz & Markus W. Büchler

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  1. Jörg Köninger
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  2. Moritz N. Wente
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  3. Beat P. Müller-Stich
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  4. Francesco F. di Mola
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  6. Ulf Hinz
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  7. Michael W. Müller
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  9. Markus W. Büchler
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Correspondence to Markus W. Büchler.

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Köninger, J., Wente, M.N., Müller-Stich, B.P. et al. R2 resection in pancreatic cancer—does it make sense?. Langenbecks Arch Surg 393, 929–934 (2008). https://doi.org/10.1007/s00423-008-0308-4

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  • DOI: https://doi.org/10.1007/s00423-008-0308-4

Keywords

  • Pancreatic cancer
  • Pancreatic surgery
  • R2 resection