Surgery for recurrent pancreatic ductal adenocarcinoma.

摘要: Pancreatic ductal adenocarcinoma remains difficult to treat with an incidence rate that almost equals its mortality rate. The American Cancer Society estimated of 33,730 and a 32,300 patients for the year 2006, which clearly underscores dismal prognosis this disease.1 cancer is now fourth leading cause cancer-related deaths in United States. Because progress has been made over last 20 years diagnostics, surgery, perioperative care, operative rates have fallen well below 5% pancreaticoduodenectomies at major centers. Nevertheless, 5-year survival resected only 15% 20%.2 This partly because even after macroscopically curative tumor resection, malignant cells are observed on edge specimens up 50% cases.3 R1-like situation explains high local recurrence rate.3 Another reason presence systemic occult disease time diagnosis most patients, occurrence distant metastasis liver (50% patients) peritoneal (25%).3–6 Until now, commonly used treatment options nonresectable pancreatic chemotherapy 5-fluorouracil or gemcitabine, palliative surgical bypass procedures, endoscopic radiologically placed stents biliary obstruction, radiation other measures.7 For recurrent cancer, there no established therapeutic strategies, although pattern known. Sperti et al8 analyzed 78 resection adenocarcinoma: 72% developed 62% had hepatic metastases. median disease-free was 7 months versus 3 recurrence. Similarly, several studies shown who develop without primary tumor, appeared better prognosis.6,9,10 efficacy combined chemoradiotherapy these recently described by Wilkowski al.11 progression-free (ie, from start chemoradiotherapy) 14.7 may be promising option. A small study Horiuchi al12 compared 2 groups metastasis: one group receiving chemotherapy. administration gemcitabine seemed prolong period mean 6.6 any therapy 22.3 months. To best our knowledge, series few cases about reresection cancer.13 On background lack effective chemotherapy,14 paper reports outcome reoperated disease. We evaluated 30 underwent radical intent (R0/R1), R2 bypass, explorative laparotomy depending extent