Adenocarcinoma of the pancreatic head : A community teaching hospital's experience from 1982 to 1992

The treatment of adenocarcinoma of the pancreatic head remains variable, with multiple therapeutic options including surgery, biliary stenting, chemotherapy, and radiation therapy. We retrospectively reviewed our experience from 1982 through 1992, which included 160 patients with this diagnosis, evaluating their treatments and outcomes. There were 66 males and 94 females, with a mean age of 70 ± 11 years. Forty patients (25%) had no surgery; of these, 27 had no further treatment, whereas 13 received chemotherapy and/or radiation therapy (CT/RT). Of 120 patients who had surgical exploration, only 19 (16%) were resectable for a potential cure. Eleven of these resected patients had no additional therapy, whereas 8 patients received adjuvant CT/RT. Of the 101 unresectable patients, 62 had no further therapy and 39 received CT/RT. Twenty-two patients (14%) had biliary stents placed, 11 in lieu of surgery, 7 preoperatively, and 4 postoperatively. Perioperative mortality was no different for resectable patients (16%) versus unresectable patients (14%). Overall, 90 patients (56%) had one or more complications related to their disease or treatment, with no differences between groups. Median survivals were as follows: no treatment, 1 month; no surgery with CT/RT, 3.5 months; unresectable with no further treatment, 4 months; unresectable with CT/RT, 8 months; resection with no additonal treatment, 17 months; and resection with CT/RT, 13 months. Patients with resectable disease had a significantly longer survival than patients who had no surgery (P < 0.001) or who were unresectable at exploration (P < 0.001); the addition of CT/RT after resection had no effect on survival (P = 0.8). The addition of CT/RT significantly increased survival for patients who had no surgery (p =.001) and for patients who were explored but were unresectable (p =.002). In conclusion, despite dismal results, surgery remains the mainstay of treatment for adenocarcinoma of the pancreatic head. Although CT/RT did not increase the median survival after resection, it doubled the median survival after noncurative surgery.