Ductal Adenocarcinoma of the Body and Tail of the Pancreas Cosimo Sperti, MD, Claudio Pasquali, MD, and Sergio Pedrazzoli, MD, FACS Background: Carcinoma arising from the body and tail of the pancreas is less frequent than pancreatic head cancer, and its prognosis is known to be worse. This aggressive behavior is reported by few large clinical studies. Study Design: We retrospectively reviewed our 24 years experience on adenocarcinoma of the body and tail of the pancreas and analyzed survival and longterm results after resection. Recent large series on cancer of the distal pancreas were also reviewed. Results: Among 148 patients observed, 109 were surgi- cally treated. Resectability rate was 16%; ductal adeno- carcinoma in 22% of patients who underwent surgery was resectable. Macroscopic radical resection was achieved in only 16 cases. Overall 5-year survival rate was 2%. In resected cancers the actual 5-year survival rate was 12.5%. Patients with unresectable cancers did not survive more than 17 months. All three patients who survived more than 5 years had a small tumor (T1 according to TNM staging). In the literature, among 360 evaluable resected patients, only 7 survived at 5 years (2%). Conclusions: The prognosis for patients with adenocar- cinoma of the distal pancreas is poor, even after resec- tion of the tumor; however, the results are not substan- tially different for those reported after resection for pancreatic head carcinoma. Surgical resection can offer longterm survival for patients with localized cancer. (J Am Coll Surg 1997;185:255-259. © 1997 by the Amer- ican College of Surgeons) Carcinoma arising in the distal pancreas is gener- ally seen with advanced disease. Surgical resection for cure is less frequently achieved, compared with the most frequent carcinoma of the head of the pancreas; therefore, longterm survival is excep- tional (1-7). The literature is replete with large, retrospective surveys of institutional series on the surgical treatment of the carcinoma of the head of the pancreas. On the contrary, surgical results on Received February 13, 1997; Revised May 6, 1997; Accepted May 8, 1997. From the Department of Surgery, University of Padua, Padua, Italy. Study supported by a grant of the Italian National Research Council (C.N.R.), contract nr. 96.00611.PF39. Correspondence address: Dr. Claudio Pasquali, MD, Istituto di Se- meiotica Chirurgica, University of Padova, Ospedale Busonera, via Gattamelata 64, 35128 Padova, Italy. carcinoma of the body and tail have been reported only by a few large series (8-17); this probably reflects the limited experience of most of the sur- geons or a defeatist attitude toward this type of cancer. The aim of this study was to review our experience on adenocarcinoma of the body and tail of the pancreas and to evaluate longterm re- sults of surgical treatment. Methods From 1970-1993, 148 patients were diagnosed with a histologically (n = 109) or cytologically (n = 39) proved adenocarcinoma arising from the body or tail of the pancreas, of a total 556 patients (26.6%) with pancreatic cancer observed in our department. Neoplasms of the periampullary re- gion and of the head, neck, or uncinate process of the pancreas were not included. Patients with cys- tic neoplasm or islet cell tumor were excluded from the study. Surgical resection was performed whenever possible, and no liver or peritoneal met- astatic disease was evident. Curative resection was defined as resection with the removal of all gross tumor and negative microscopic margins. At the time of surgery, pancreatic carcinoma was staged following the pTNM (Union Internationale Con- tra le Cancer) system (18). Operative mortality was defined as any death occurring before discharge from the hospital. Followup of the patients in- cluded clinical evaluation, routine laboratory tests after 1 month of operation, followed by abdominal ultrasound, computed tomography (when avail- able), or chest x-ray every 3 months. No patient was treated with adjuvant radiotherapy or chemother- apy. Causes of death and sites of recurrence were obtained from death certification, medical interview, radiologic assessment, surgical exploration, or au- topsy. Date of recurrence after curative resection was defined as the date of the clinical diagnosis of recur- rence. Sites of treatment failure were those present at the initial diagnosis of recurrent disease. Survival was then evaluated and survival rates are expressed as crude survival at 1, 3, and 5 years. Results Of the 148 patients, 109 (74%) underwent opera- tion (Table 1). Fifty-eight of the operations (53%) © 1997 by the American College of Surgeons ISSN 1072-7515/97/$17.00 Published by Elsevier Science Inc. 255 PII S1072-7515(97)00056-2