Skip to main content
Log in

Impact of Adjuvant Gemcitabine Plus S-1 Chemotherapy After Surgical Resection for Adenocarcinoma of the Body or Tail of the Pancreas

  • original article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Few patients with pancreatic body or tail carcinoma are candidates for surgical resection, and the efficacy of postoperative adjuvant chemotherapy for patients with pancreatic body or tail carcinoma has not been elucidated. The aim of this study was to determine the effect of adjuvant gemcitabine and S-1 therapy for patients with adenocarcinoma of the body or tail of the pancreas who had undergone surgical resection by distal pancreatectomy.

Materials and Methods

Medical records of 34 patients with pancreatic body or tail carcinoma who underwent surgical resection were reviewed retrospectively. Eighteen patients received postoperative adjuvant gemcitabine and S-1 chemotherapy. Univariate and multivariate models were used to analyze the effect of various clinicopathological factors on long-term survival.

Results

There were no deaths due to surgery. Overall, 1-, 2-, and 5-year survival rates were 69%, 40%, and 25%, respectively (median survival time, 14.4 months). Univariate analysis revealed that adjuvant gemcitabine plus S-1 chemotherapy, blood transfusion, splenic artery invasion, lymph node metastasis, surgical margin status, and International Union Against Cancer stage were associated significantly with long-term survival (P < 0.05). Furthermore, use of a Cox proportional hazards regression model indicated that adjuvant gemcitabine plus S-1 chemotherapy and absence of lymph node metastasis were significant independent predictors of a favorable prognosis (P < 0.05).

Conclusion

Postoperative adjuvant gemcitabine plus S-1 chemotherapy may improve survival after surgical resection for pancreatic body or tail carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Ohge H, et al. Postoperative adjuvant chemotherapy improves survival after surgical resection for pancreatic carcinoma. J Gastrointest Surg 2008;12:534–541. doi:10.1007/s11605-007-0407-5.

    Article  PubMed  Google Scholar 

  2. Takai S, Satoi S, Toyokawa H, Yanagimoto H, Sugimoto N, Tsuji K, et al. Clinicopathologic evaluation after resection for ductal adenocarcinoma of the pancreas: A retrospective, single-institution experience. Pancreas 2003;26:243–249. doi:10.1097/00006676-200304000-00007.

    Article  PubMed  CAS  Google Scholar 

  3. Tani M, Kawai M, Terasawa H, Ina S, Hirono S, Uchiyama K, et al. Does postoperative chemotherapy have a survival benefit for patients with pancreatic cancer? J Surg Oncol 2006;93:485–490. doi:10.1002/jso.20440.

    Article  PubMed  Google Scholar 

  4. Nakao A, Harada A, Nonami T, Kaneko T, Takagi H. Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 1996;12:357–361. doi:10.1097/00006676-199605000-00006.

    Article  PubMed  CAS  Google Scholar 

  5. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594. doi:10.1002/bjs.4484.

    Article  PubMed  CAS  Google Scholar 

  6. Magistrelli P, Antinori A, Crucitti A, La Greca A, Masetti R, Coppola R, et al. Prognostic factors after surgical resection for pancreatic carcinoma. J Surg Oncol 2000;74:36–40. doi:10.1002/1096-9098(200005)74:1<36::AID-JSO9>3.0.CO;2-F.

    Article  PubMed  CAS  Google Scholar 

  7. Brown KM, Domin C, Aranha GV, Yong S, Shoup M. Increased preoperative platelet count is associated with decreased survival after resection for adenocarcinoma of the pancreas. Am J Surg 2005;189:278–282. doi:10.1016/j.amjsurg.2004.11.014.

    Article  PubMed  Google Scholar 

  8. Gebhardt C, Meyer W, Reichel M, Wunsch PH. Prognostic factors in the operative treatment of ductal pancreatic carcinoma. Langenbecks Arch Surg 2000;385:14–20. doi:10.1007/s004230050004.

    Article  PubMed  CAS  Google Scholar 

  9. Berger AC, Meszoely IM, Ross EA, Watson JC, Hoffman JP. Undetectable preoperative levels of serum CA 19-9 correlate with improved survival for patients with resectable pancreatic adenocarcinoma. Ann Surg Oncol 2004;11:644–649. doi:10.1245/ASO.2004.11.025.

    Article  PubMed  Google Scholar 

  10. Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-delCastillo C, Warshaw AL. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol 2006;24:2897–2902. doi:10.1200/JCO.2005.05.3934.

    Article  PubMed  CAS  Google Scholar 

  11. Shoup M, Conlon KC, Klimstra D, Brennan MF. Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg 2003;7:946–952. doi:10.1016/j.gassur.2003.08.004.

    Article  PubMed  Google Scholar 

  12. Sperti C, Pasquali C, Pedrazzoli S. Ductal adenocarcinoma of the body and tail of the pancreas. J Am Coll Surg 1997;185:255–259.

    PubMed  CAS  Google Scholar 

  13. Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 1996;223:506–511. doi:10.1097/00000658-199605000-00006.

    Article  PubMed  CAS  Google Scholar 

  14. Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 2006;139:288–295. doi:10.1016/j.surg.2005.08.004.

    Article  PubMed  Google Scholar 

  15. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, et al. Resected adenocarcinoma of the pancreas-616 patients: Results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567–579. doi:10.1016/S1091-255X(00)80105-5.

    Article  PubMed  CAS  Google Scholar 

  16. Ozaki H, Kinoshita T, Kosuge T, Yamamoto J, Shimada K, Inoue K, et al. An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas. Cancer 1996;77:2240–2245. doi:10.1002/(SICI)1097-0142(19960601)77:11<2240::AID-CNCR9>3.0.CO;2-T.

    Article  PubMed  CAS  Google Scholar 

  17. Nakao A, Harada A, Nonami T, Kaneko T, Nomoto S, Koyama H, et al. Lymph node metastasis in carcinoma of the body and tail of the pancreas. Br J Surg 1997;84:1090–1092. doi:10.1002/bjs.1800840813.

    Article  PubMed  CAS  Google Scholar 

  18. Christein JD, Kendrick ML, Iqbal CW, Nagorney DM, Farnell MB. Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg 2005;9:922–927. doi:10.1016/j.gassur.2005.04.008.

    Article  PubMed  Google Scholar 

  19. Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: Ability to obtain negative tangential margins. J Am Coll Surg 2007;204:244–249. doi:10.1016/j.jamcollsurg.2006.11.002.

    Article  PubMed  Google Scholar 

  20. Hirano S, Kondo S, Hara T, Ambo Y, Tanaka E, Shichinohe T, et al. Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic body cancer: Long-term results. Ann Surg 2007;246:46–51. doi:10.1097/01.sla.0000258608.52615.5a.

    Article  PubMed  Google Scholar 

  21. Shirasaka T, Shimamato Y, Ohshimo H, Yamaguchi M, Kato T, Yonekura K, et al. Development of a novel form of an oral 5-fluorouracil derivative (S-1) directed to the potentiation of the tumor selective cytotoxicity of 5-fluorouracil by two biochemical modulators. Anticancer Drugs 1996;7:548–557. doi:10.1097/00001813-199607000-00010.

    Article  PubMed  CAS  Google Scholar 

  22. Tsujie M, Nakamori S, Nakahira S, Takeda S, Takahashi Y, Hayashi N, et al. Schedule-dependent therapeutic effects of gemcitabine combined with Uracil-Tegafur in a human pancreatic cancer xenograft model. Pancreas 2006;33:142–147. doi:10.1097/01.mpa.0000226882.48204.26.

    Article  PubMed  CAS  Google Scholar 

  23. Nakamura K, Yamaguchi T, Ishihara T, Sudo K, Kato H, Saisho H. Phase II trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer 2006;94:1575–1579.

    PubMed  CAS  Google Scholar 

  24. Murakami Y, Uemura K, Sudo T, Hayashidani Y, Hashimoto Y, Nakagawa N, et al. Adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic adenocarcinoma. Am J Surg 2008;195:757–762. doi:10.1016/j.amjsurg.2007.04.018.

    Article  PubMed  CAS  Google Scholar 

  25. Murakami Y, Uemura K, Ohge H, Hayashidani Y, Sudo T, Sueda T. Intraductal papillary-mucinous neoplasms and mucinous cystic neoplasms of the pancreas differentiated by ovarian-type stroma. Surgery 2006;140:448–453. doi:10.1016/j.surg.2006.03.017.

    Article  PubMed  Google Scholar 

  26. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Sueda T. Predictive factors of malignant or invasive intraductal papillary-mucinous neoplasms of the pancreas. J Gastrointest Surg 2007;11:338–344. doi:10.1007/s11605-006-0069-8.

    Article  PubMed  Google Scholar 

  27. International Union Against Cancer (UICC). TNM classification of malignant tumors. 6th ed. New York: Wiley-Liss, 2002.

    Google Scholar 

  28. Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, European Study Group for Pancreatic Cancer, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210. doi:10.1056/NEJMoa032295.

    Article  PubMed  CAS  Google Scholar 

  29. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: A randomized controlled trial. JAMA 2007;297:267–277. doi:10.1001/jama.297.3.267.

    Article  PubMed  CAS  Google Scholar 

  30. Stocken DD, Buchler MW, Dervenis C, Bassi C, Jeekel H, Klinkenbijl JH, Pancreatic Cancer Meta-analysis Group, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005;92:1372–1381. doi:10.1038/sj.bjc.6602513.

    Article  PubMed  CAS  Google Scholar 

  31. Murakami Y, Uemura K, Sasaki T, Hayashidani Y, Sudo T, Sueda T. Long-term survival of pancreatic cancer patient diagnosed by positive telomerase activity of pancreatic juice. Surgery 2005;138:962–963. doi:10.1016/j.surg.2005.07.031.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshiaki Murakami.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Murakami, Y., Uemura, K., Sudo, T. et al. Impact of Adjuvant Gemcitabine Plus S-1 Chemotherapy After Surgical Resection for Adenocarcinoma of the Body or Tail of the Pancreas. J Gastrointest Surg 13, 85–92 (2009). https://doi.org/10.1007/s11605-008-0650-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0650-4

Keywords

Navigation