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A randomized multicenter trial comparing resection and radiochemotherapy for resectable locally invasive pancreatic cancer
- Source :
- Surgery. 136:1003-1011
- Publication Year :
- 2004
- Publisher :
- Elsevier BV, 2004.
-
Abstract
- Though the outcome of resection for locally invasive pancreatic cancer is still poor, it has gradually improved in Japan, and the 5-year survival is now about 10%. However, the advantage of resection over radiochemotherapy has not yet been confirmed by a randomized trial. We conducted this study to compare surgical resection alone versus radiochemotherapy without resection for locally invasive pancreatic cancer using a multicenter randomized design.Patients with pancreatic cancer who met our preoperative criteria for inclusion (pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric artery or the common hepatic artery, or without distant metastasis) underwent laparotomy. Patients with operative findings consistent with our criteria were randomized into a radical resection group and a radiochemotherapy group (200 mg/m(2)/day of intravenous 5-fluorouracil and 5040 cGy of radiotherapy) without resection. The 2 groups were compared for mean survival, hazard ratio, 1-year survival, quality of life scores, and hematologic and blood chemical data.Twenty patients were assigned to the resection group and 22 to the radiochemotherapy group. There was 1 operative death. The surgical resection group had better results than the radiochemotherapy group as measured by 1-year survival (62% vs 32 %, P=.05), mean survival time (17 vs 11 months, P.03), and hazard ratio (0.46, P=.04). There were no differences in the quality of life score or laboratory data apart from increased diarrhea after surgical resection.Locally invasive pancreatic cancer without distant metastases and major arterial invasion appears to be best treated by surgical resection.
- Subjects :
- Adult
medicine.medical_specialty
Time Factors
Pancreatic disease
Biopsy
medicine.medical_treatment
Japan
Laparotomy
medicine.artery
Multicenter trial
Pancreatic cancer
medicine
Humans
Neoplasm Invasiveness
Aged
Sex Characteristics
Common hepatic artery
business.industry
Hazard ratio
Middle Aged
medicine.disease
Survival Analysis
Surgery
Pancreatic Neoplasms
Radiation therapy
Lymphatic Metastasis
Quality of Life
business
Chemoradiotherapy
Subjects
Details
- ISSN :
- 00396060
- Volume :
- 136
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....d99ec8a16090021aea5f6a72c6b5a778