Quelle est la place de la chirurgie dans l'adénocarcinome pancréatique localement évolué ? What is the place of surgery in locally advanced pancreatic adenocarcinoma?

Pancreatic cancer isthe fifth leading cause of cancer deaths in western countries and his incidence is increasing. The resection pancreatic cancers have unfortunately changed little and remains very low with rates not exceeding 22% for the best teams. We present a retrospective study over a period of 8 years, having to compile 61 patients, which we intend to discuss the clinical and paraclinical aspects, and try to empha- size, in the light of data from the review, objective criteria of resecability operable in a patient carrying a no metastatic and locally advanced pancreatic tumor. Patient and method: We present a retrospective study, over 8 years (between January 1999 and December 2006), of 61 cases of pancreatic cancer. The average age of our patients was 61 years with sex ratio at 1, 65. The jaundice and weight loss are the principal symptoms. Radiological examination (US and CT scan) radiology ultrasonography and scanner confirm the diagnosis in 81% cases. The operability was at 83% and the resecability at 31%. A curative surgery was carried out in 15 cases. The mortality rate was 2% and the morbidity rate was 21%. The survival of the patients not operated was 4 vs 11 months for the patients who had pal- liative surgery (P < 0.001). The survical rate in patients with cure resection was 28 vs 14 months in palliative resection R1 (P < 0.01). Three years survival rate was 31%. Conclusion: Very high frequency of metastatic forms or locally advanced that less than 20% of patients are carriers of a resectable tumor at the time of diagnosis. Surgical resec- tion alone can bring prolonged survival although survival at 5 years was much discussed with values of less than 15%.