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

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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.

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Author information

Authors and Affiliations

  1. Department of Surgery, Kyoto University, 54 Shogoinkawaracho, Sakyo-ku, Kyoto, 606-8507, Japan

    Ryuichiro Doi, Masayuki Imamura & Ryo Hosotani

  2. Department of Gastroenterological Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Toshihide Imaizumi, Takashi Hatori & Ken Takasaki

  3. Department of Gastroenterology, National Kyushu Cancer Center, Fukuoka, Japan

    Akihiro Funakoshi & Hideyuki Wakasugi

  4. Second Department of Surgery, Chiba University, Chiba, Japan

    Takehide Asano

  5. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan

    Shoichi Hishinuma & Yoshiro Ogata

  6. First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan

    Makoto Sunamura

  7. Department of Surgery and Oncology, Kyushu University, Fukuoka, Japan

    Koji Yamaguchi & Masao Tanaka

  8. Department of Surgical Oncology and Digestive Surgery, Kagoshima University, Kagoshima, Japan

    Sonshin Takao & Takashi Aikou

  9. First Department of Surgery, Sapporo Medical University, Sapporo, Japan

    Koichi Hirata

  10. Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan

    Hiroyuki Maguchi

  11. Department of Surgery, Keio University, Tokyo, Japan

    Koichi Aiura

  12. Department of Surgery, Tokyo Medical College, Tokyo, Japan

    Tatsuya Aoki

  13. Department of Surgery, Kitasato University, Kanagawa, Japan

    Akira Kakita

  14. Department of Surgery, National Nagasaki Medical Center, Nagasaki, Japan

    Makoto Sasaki

  15. Department of General Surgery, Yokohama Rousai Hospital, Yokohama, Japan

    Masahiko Ozaki

  16. Department of Abdominal Surgery, Tenri Hospital, Nara, Japan

    Satoru Matsusue

  17. Department of Surgery, Nagahama City Hospital, Nagahama, Japan

    Shunichi Higashide & Hideki Noda

  18. First Department of Surgery, Fukuoka University, Fukuoka, Japan

    Seiyo Ikeda

  19. Tenri Institute of Medical Research, Nara, Japan

    Shunzo Maetani

  20. National Cancer Center Hospital East, Chiba, Japan

    Shigeaki Yoshida

Authors
  1. Ryuichiro Doi
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  2. Masayuki Imamura
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  3. Ryo Hosotani
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  4. Toshihide Imaizumi
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  5. Takashi Hatori
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  6. Ken Takasaki
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  7. Akihiro Funakoshi
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  8. Hideyuki Wakasugi
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  9. Takehide Asano
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  15. Sonshin Takao
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  16. Takashi Aikou
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  17. Koichi Hirata
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The Japan Pancreatic Cancer Study Group

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Doi, R., Imamura, M., Hosotani, R. et al. Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: Final results of a randomized multi-institutional trial. Surg Today 38, 1021–1028 (2008). https://doi.org/10.1007/s00595-007-3745-8

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  • DOI: https://doi.org/10.1007/s00595-007-3745-8

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