One of the major limitations of curative resection in patients with pancreatic cancer is local tumor extension to the mesenteric vessels. Thus, the purposes of our study were to assess the clinical value of contrast-enhanced spiral computed tomography (CT) in predicting the resectability and survival of patients with pancreatic cancer with suspicious vascular invasion and to assess the influence of curative resection on the survival of these patients. We enrolled 40 patients with pancreatic cancer who were suspected of having an involvement of the adjacent large vessels and who subsequently underwent operation with curative intent in the study. Resectability and survival were correlated with CT findings such as segment length, degree of encasement, and type and number of vessels involved. The survival rate was compared between the curative and palliative resection groups, and survival rate was compared between the resected and unresected groups. Of the 40 patients with adenocarcinoma of the pancreas, 14 had curative resections and 26 had palliative resections. The probability of curative resection was higher in patients with segment lengths less than 2 cm, as compared with segment lengths more than 2 cm. However, there was no difference in survival between the two groups. There were no differences in resectability and survival according to the degree of encasement and type and number of vessels involved. There was no difference in survival between the curative and palliative resection groups. There was no difference in survival between the resected and unresected groups. A survival benefit was not achieved by curative resection in patients with pancreatic cancer with vascular invasion. Therefore, it would be better to avoid aggressive surgery in patients with pancreatic cancer with vascular invasion.
From the Departments of Gastroenterology (D.I.P., J.K.L., J.-E.K., J.G.H., S.G.S., K.T.L., S.W.P., J.C.R., K.W.C.) , Radiology (J.H.L.), and Surgery (Y.I.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Submitted January 12, 2000.
Accepted April 11, 2000.
Address correspondence and reprint requests to Dr. J.K. Lee, Department of Gastroenterology, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Gu, Seoul 130–10, Korea. E-mail: firstname.lastname@example.org