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Consecutive re-explorations for final resection of initially unresectable pancreatic head carcinoma.

BACKGROUND/AIMS
The lack of high surgical expertise and specialization of the practicing surgeon may lead some patients with pancreatic cancer to die. This study also investigates the role of combined neo and adjuvant locoregional immunochemotherapy in patients considered initially as non-amenable to resection.


METHODOLOGY
32 patients underwent re-exploration aiming at pancreatic resection. After the initial diagnostic work-up 22 of them underwent pancreatic resection during the first re-exploration. The remaining 10 patients were judged again as unresectable. All 32 patients had 2 catheters introduced into a side arterial branch of the jejunal artery and vein for locoregional immunochemotherapy. Seven out of 10, considered as unresectable initially, had pancreatic resection after immunochemotherapy regimen.


RESULTS
All patients survived surgery. Early morbidity included wound infection in 3, bleeding in 1 and leakage of gastric stump in 1 patient. Treatment related toxicity included leukopenia in 4 patients, anemia in 3 and fever and chills in 21. Mean follow-up was 62 +/- 1.2 months. One-, 2-, 3- and 5-year survival was 100, 80, 70 and 48% respectively.


CONCLUSIONS
Our results strongly support the necessity for neo and adjuvant locoregional immunochemotherapy and its contribution to prolongation of survival.