Diagnosis And Treatment Of 124 Patients With Pancreatic Head Cancer

Background: Pancreatic head cancer has highest lethality among all gastrointestinal tumors with rising incidence and a still-dismal prognosis. Difficulty of early diagnosis, lower resectional rates and short postoperational survival pose great threat to people's health. Great advancements have been made in recent decades, such as improvement of surgical skills and perioperational management, which have contributed to higher resectional rates and decreased postoperational mortality. While long-term survival in patients with pancreatic head cancer is still unsatisfying.Objective: To explore management strategy for patients with pancreatic head cancer and study prognostic factors influencing short-and long term of survival.Methods: We retrospectively investigated medical records of 124 patients with pancreatic head cancer treated at the department of Hepato-biliary-pancreatic Surgery of the 2nd Xiang-Ya Hospital, Central South University , during the 10-year period from Jan. 1997 to Dec. 2006, also reviewed all relevant articles in the past 5 years through PubMed searching. Clinicopathologic factors were evaluated for their association with survival in univariate and multivariate analysis using Cox proportional hazard model.Results: 1. Among all 124 cases, jaundice (73 patients) was the most common indicator, followed by upper abdominal pain (68 patients), weight loss (37 patients) and upper abdominal uncomfortableness (30 patients). According to the UICC/ AJCC (6th edition) staging system, results of tumor stage were as followed: one patients had stage IA tumors, 10 had IB stage tumors, 23 had IIA stage tumors, 22 had IIB stage tumors,38 had III stage tumors and 30 had stage IV tumors.2. Early diagnosis was possible in 11 cases (9.5%, 11/124).3. All 124 patients underwent laparotomy following preoperative assessment of extent of disease and 33 patients (resectability rate 26.61%, 33/124) ultimately underwent resection with curative intent. In the resection group, radical resection was possible in 30 patients, while palliative resection in 3 patients. The 1-, 3-and 5-year survival rates were 85.0% (17/20). 30.0%(6/20) and 15.0%(3/20) in radical resection group , respectively, with median survival time 22 months. Survival rates after resection were significantly higher than those after palliative drainage and exploratory laparotomy (P<0.001).Also higher survival rates were seen in radically resected patients when compared with other surgically treated patients (P＜0.001). No statistically significant difference was seen when compared with other groups (P>0.05 ) .4. Prognosis analysis revealed that type of surgery, pathologic findings, tumor diameter, lymphatic metastasis, distant metastasis and pTNM stage as independent prognostic factors affecting survival.Conclusions: 1. Improvement of early diagnosis may eventually lead to higher resectional rates and better long-term survival for patients with pancreatic head cancer.2. Computed tomography (CT) may be served as an important radiological tool for diagnosis and evaluation of resectionability of pancreatic head cancer.3. Radical resectional surgery can provide chance to achieve the possibility of cure and long-term survival. Pancreatoduodenectomy combined with vein resection or reconstruction can achieve higher rates of free tumor resectional margin and may lead to longer postoperational survival.4. Histological classification, pTNM stage and type of surgical treatment are important prognostic factors influencing survival for patients with pancreatic head cancer.