Mortality and morbidity of pancreatic surgery have decreased to acceptable levels.
The complex question arises whether pancreatic resection should be performed in patients with preoperatively doubtful resectable pancreatic cancer.
Dr Kuhlmann and colleagues from the Netherlands assessed 80 patients who underwent a microscopically incomplete resection.
The investigators compared the results with those of 90 patients who underwent a bypass for locally advanced disease for pancreatic adenocarcinoma.
All patients initially underwent exploratory laparotomy with the intention to perform a resection.
The investigative team evaluated quality of life by analyzing readmissions and their indications.
|Hospital mortality was nil after incomplete resection|
Groups were similar with respect to age, presenting symptoms, and preoperative health status.
The team found that tumors were significantly larger in the bypass group.
Hospital mortality was comparable, and was nil after incomplete resection and 2% after bypass.
Of all severe complications, only intra-abdominal hemorrhage occurred more frequently after resection, at 10% vs 2% in the bypass group.
Hospital stay after resection was 16 days, and significantly longer than after bypass at 10 days.
The team noted that survival was significantly longer after resection, and was 16 months vs 10 months with bypass.
The investigators found that 61% of patients were readmitted for a total of 215 admissions, equally distributed between groups.
The team observed that the total survival time after initial discharge spent in the hospital was not significantly different between the groups.
Dr Kuhlmann's team commented, “Microscopically incomplete pancreatic resection and bypass for locally advanced disease can be performed with comparable low mortality and morbidity rates.”
“Readmission rates are also comparable between groups and time spent in the hospital after initial discharge is low.”
“Because resection offers adequate palliation in pancreatic cancer, a more aggressive surgical approach in patients who are found to have a doubtfully resectable tumor could be advocated, even if only an incomplete resection can be achieved.”