Surgical treatment and prognostic factors in TS1 carcinoma of the pancreas

After classifying 72 resected ductal carcinomas of the pancreas on the basis of tumor size (TS) into the following categories: TS1 (≦2.0cm,n=9), TS2 (>2.0cm, ≦4.0cm,n=37), and TS3,4 (>4.0cm,n=26), we investigated both clinicopathological and biological factors, and assessed their relation to long-term outcome. The 5-year survival rate was 44.4% in the TS1 patients, 9.0% in the TS2 patients, and 4.5% in the TS3,4 patients, being significantly higher in the TS1 patients. Six patients survived for more than 5 years, including 2 TS1 patients with conclusive stage I disease, and their clinicopathological and/or biological factors were negative. Most of the 72 patients, however, were not only very advanced macro-microscopically but their biological malignant potential was also high. These patients with advanced disease, especially those with noncurative resection (curability C), had a poor outcome. The TS1 patients, on the other hand, were characterized by a better outcome than the TS2 and TS3,4 patients after curable resection combined with N2 lymph node dissection, even when the tumor extension was the same. Thus, survivals of more than 5 years can be expected in TS1 patients with stage I, or in patients with stage III or IV, if the histological factors and/or biological factors are negative. All patients who died of early recurrence after resection had some positive histological and biological factors. Liver metastasis was especially frequent when two or more biological factors were positive. Therefore, in advanced TS1 patients (stage III or IV), radical resection should be performed, followed by adjuvant chemotherapy.