Resectability of the pancreatic adenocarcinoma: A study from Iran


1 Department of Gastroenterology, Yazd Shaheed Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Nursing, Esfahan University of Medical Sciences, Esfahan, Iran

4 Department of Gastroenterology, Tehran University of Medical Sciences, Tehran, Iran


Background: Definite treatment of pancreatic adenocarcinoma is surgical resection. Absence of early symptoms in most patients leads to late diagnosis and treatment. This study aims to evaluate resectability of the pancreatic adenocarcinoma at the time of the diagnosis in Iran.
Materials and Methods: The present study which is of a descriptive, prospective and case series nature, has been studying the resectability of the pancreatic adenocarcinoma by multi-detector computerized tomography, endoscopic ultrasonography, laparoscopy and/or laparotomy in 157 patients for the duration of 2 years since November 2009.
Results: A total of 157 patients were enrolled in this study. Majority of them (68%) were male. The mean age was 67 years. Final diagnosis obtained 1-12 (2.7 ± 1.6) months after beginning of the symptoms. The lesion situated in the head of the pancreas in 127 cases (81%). Vascular invasion, lymphadenopathy, liver metastasis and peritoneal involvement were seen in 88%, 57%, 43% and 19% of the patients, respectively. According to imaging, tumor was resectable in 10 (6%) patients but laparoscopy and/or laparotomy revealed that only five cases (3%) were actually resectable. After 24 months, only 8 patients were alive; 5 cases of them had been treated by Whipple surgery and other 3 cases were under the chemotherapy. At 1 and 2 year survival rate of the patients was 11% and 5%, respectively.
Conclusion: Majority (97%) of the pancreatic adenocarcinomas are unresectable at the time of diagnosis. Thus, meticulous preoperative assessment of patients is essential in patients to avoid major surgery in unresectable cases.


Feldman M, Friedman S, Brandt J. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9 th ed. Philadelphia: Frank Polizzano; 2010.  Back to cited text no. 1
Hruban RH, Pitman MB, Klimstra DS. AFIP Atlas of Tumor Pathology. Tumors of the Pancreas. Washington, D.C.: American Registry of Pathology; 2007. p. 111-64.  Back to cited text no. 2
Solcia E, Capella C, Kloppel G Tumors of the Pancreas. Washington, D.C.: Armed Forces Institute of Pathology; 1997. p. 31-144.  Back to cited text no. 3
Coley SC, Strickland NH, Walker JD, Williamson RC. Spiral CT and the pre-operative assessment of pancreatic adenocarcinoma. Clin Radiol 1997;52:24-30.  Back to cited text no. 4
Freeny PC, Traverso LW, Ryan JA. Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 1993;165:600-6.  Back to cited text no. 5
Megibow AJ, Zhou XH, Rotterdam H, Francis IR, Zerhouni EA, Balfe DM, et al. Pancreatic adenocarcinoma: CT versus MR imaging in the evaluation of resectability - Report of the Radiology Diagnostic Oncology Group. Radiology 1995;195:327-32.  Back to cited text no. 6
Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: Criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol 1997;168:1439-43.  Back to cited text no. 7
O'Malley ME, Boland GW, Wood BJ, Fernandez-del Castillo C, Warshaw AL, Mueller PR. Adenocarcinoma of the head of the pancreas: Determination of surgical unresectability with thin-section pancreatic-phase helical CT. AJR Am J Roentgenol 1999;173:1513-8.  Back to cited text no. 8
Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS. The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: Correlation with findings at surgery. AJR Am J Roentgenol 1997;168:971-7.  Back to cited text no. 9
Gress F, Gottlieb K, Sherman S, Lehman G. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med 2001;134:459-64.  Back to cited text no. 10
Baghbanian M, Shabazkhani B, Ghofrani H, Forutan H, Dariani N, Farahvash M, et al. Efficacy of endoscopic ultrasound guided fine needle aspiration in patients with solid pancreatic neoplasms. Saudi J Gastroenterol 2012;18:358-63.  Back to cited text no. 11
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Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet 2004;363:1049-57.  Back to cited text no. 12
13. Sohn TA, Lillemoe KD, Cameron JL, Huang JJ, Pitt HA, Yeo CJ. Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. J Am Coll Surg 1999;188:658-66.  Back to cited text no. 13