Review
Copyright ©2006 Baishideng Publishing Group Co.
World J Gastroenterol. Jul 28, 2006; 12(28): 4466-4472
Published online Jul 28, 2006. doi: 10.3748/wjg.v12.i28.4466
Table 1 Comparative studies of extended versus standard operation for pancreatic cancer
AuthorYrResults
Ishikawa et al[24]1988Retrospective studystandard (n = 37): 9%, 5-Y-S
extended (n = 22): 28%, 5-Y-S
Mukaiya et al[25]1998Retrospective study 77 institutions, 501 patients: NS
Henne-Bruns et al[26]2000Retrospective studystandard (n = 26)NS
extended (n = 46)
Pedrazzoli et al[27]1998RCTstandard (n = 40)overall survival: NS
extended (n = 41)survival of node positive patients: extended > standard
Yeo et al[28]2002RCTstandard (n = 146)mortality: NS, morbidity: extended > standard,
extended (n = 148)survival: NS
Table 2 Incidence of postoperative recurrence in pancreatic cancer
AuthorYrCases (n)Liver (%)Local (%)Peritoneal (%)Bone (%)Lung (%)Other (%)
Westerdahl et al[53]1993749286.5
Kayahara et al[54]1993306083.340
Takahashi et al[55]19952580100562456
Sperti et al[56]19977862726
Nakao et al[57]199776573441311
Table 3 Randomised controlled trials of adjuvant treatment for pancreatic ductal adenocarcima
TrialComparisonAdjuvant treatmentNumber of patientsConclusions
GITSG, 1985[58], 1987[59]CRT vs OBS2 × (20 Gy in 10 fractions + 500 mgm-2 5FU d 1-3) + weekly 5FU to recurrence49 pancreatic patients randomisedSignificant increase in median survival (20 vs 11 mo, P = 0.035) in 43 eligible patients
Norway, 1993[60]CT vs OBSAMF (40 mgm-2 doxorubicin, 6 mgm-2 mytomycin C, 500 mgm-2 5FU) once every 3 wk for six courses61 patients (47 pancreatic, 14 ampullary) randomised 46 additional nonrandomised patientsSignificant increase in median survival (23 vs 11 mo, P = 0.02) in 60 pancreatic and ampullary patients combined
EORTC, 1999[61]CRT vs OBS2 × (20 Gy in 10 fractions + 25 mgkg-1 5FU/FA d 1-5)218 patients (120 pancreatic, 93 ampullary) randomisedNS increase in median survival (25 vs 19 mo, P = 0.21) in 207 eligible patients NS increase in median survival in 114 eligible pancreatic patients (17 vs 13 mo, P = 0.099)
Japan, 2002[62]CT vs OBS6 mgm-2 mytomycin C d 1 + 310 mgm-2 5FU d 1-5 and d 15-20 followed by 100 mgm-2 oral 5FU daily until recurrence508 patients (173 pancreatic, 335 bile duct/gallbladder/ampullary) randomisedSignificant survival benefit in gallbladder No difference in 158 eligible pancreatic patients No difference in 48 eligible ampullary patients
ESPAC1, 2001[63], 2004[64]CRT vs no CRT CT vs no CT2 × (20 Gy in 10 fractions + 500 mgm-2 5FU/FA d 1-3)(20 mgm-2 FA + 425 mgm-2 5FU d 1-5) × six cycles289 pancreatic patients randomisedNS decrease in survival for CRT (P = 0.05) in 289 patients Significant increase in survival for CT (P = 0.009) in 289 eligible patients
CONKO-001, 2005[65]CT vs OBS1 gm-2 GEM, d 1, 8, 15, every 4 wk for 6 mo368 pancreatic patients randomisedSignificant increase in median DFS (14.2 vs 7.5 mo, P < 0.05) in 356 eligible patients
Table 4 Incidence of pancreatic cancer cells in peripheral blood, bone marrow, and liver tissue
AuthorYrIncidence
Tada et al[71]1993Peripheral blood, K-ras 2/6 (33%)
Juhl et al[72]1994Bone marrow, immunostaining: 15/26 (58%)
Inoue et al[73]1995Liver tissue, K-ras: 13/17 (76%)
Nomoto et al[74]1996Peripheral blood, K–ras: postoperative period10/10 (100%)
Funaki et al[75]1996Peripheral blood, CEAmRNA: 3/9 (33%)
Aihara et al[76]1997Peripheral blood, Keratin 19m RNA: 2/38 (5%)
Miyazono et al[77]1999Peripheral blood, CEAmRNA: 13-21 (61.9%)
Uemura et al[78]2004Peripheral blood, K-ras: 9/26 (35%)
Table 5 Reports of occult lymph node metastasis
AuthorYrResults
Tian et al[79]1992HE: 8/56 (14%) Cytokeratin: 17/56 = (30%)
Ando et al[80]1997K-ras: paraaortic lymph nodes: 42/101 (42%)
Demeure et al[81]1998K-ras: Stage I (T1-2, N0, M0) 16/22 (73%)
Yamada et al[82]2000K-ras (-) has a better prognosis than K-ras (+)
Bogoevski et al[83]2004Ber–EP4: immunostaining 56/148 (37.8%)
Table 6 Incidence of occult peritoneal dissemination
AuthorYrResults
Lei et al[84]1994Peritoneal washings, conventional cytology, 3/36 (8%), 1/11 (9%) with ascites
Juhl et al[72]1994Immunostaining (CEA, CA19-9,…, cytokeratin bone marrow 58%, peritoneal washings 58%
Vogel et al[85]1999Peritoneal washings 39%, bone marrow 38%, one of them positive: died within 19 mo, both negative: 5 y.s. 30% (P < 0.0001)
Castillo et al[86]1995Laparoscopy 16/94 (17%)
Leach et al[87]19964/60 (7%)
Nomoto et al[88]1997Conventional: 0/18 (0%), immunostaining (CEA, CA19-9): 2/18 (11%)
Nakao et al[89]1999Conventional: 5/66 (8%), immunostaining 14/66 (22%) prognosis between cytology positive and negative: NS