Radical resection for pancreatic cancer

Ductal adenocarcinoma of the pancreas is still characterized by (1) poor prognosis after surgery and (2) extreme difficulty in early diagnosis, and we need a breakthrough. For the first problem, we have performed a wide range of lymphatic and connective tissue clearance (extended pancreatectomy) which has succeeded in improving the 5-year survival rate from 8% to 24% via decreasing the incidence of locoregional recurrence. When liver perfusion chemotherapy via the hepatic artery and the portal vein was added to the patients who had received extended pancreatect-omy, the 5-year survival rate was further elevated to 40% via decreas- ing the incidence of hepatic metastasis. We conclude that pancre- atic cancer should be treated by the better-balanced treatments between locoregional control and prevention of hepatic metastasis. For the second problem, we have more actively collected pancre- atic juice to perform cytodiagnosis even though no obvious tumor was delineated by the conventional imaging diagnoses. When can- cer cells were detected in the pancreatic juice, our method of intra- operative cytology was very useful in precisely locating the occult lesion indicating an appropriate range of pancreatectomy. The resected pancreas was proven to have included borderline malig- nancy and in situ or minimally-invasive carcinoma by the post- operative histology, and disease-free 5-year survival rate was 100%. In the future, we need to detect patients with a high risk of pancreatic cancer and develop a less-painful method to collect the pancreatic juice. (Acta gastroenterol. belg., 2002, 65, 166-170).