Regional chemotherapy to prevent hepatic metastasis after resection of pancreatic cancer.

BACKGROUND/AIMS: Liver metastasis is one of the major causes of cancer death after resection of pancreatic cancer. To deal with this problem, we developed a liver perfusion chemotherapy via the hepatic artery and portal vein. The present paper is designed to introduce the technique of this method and report on the promising results. METHODOLOGY: Between 1987 and 1995, 98 consecutive patients with adenocarcinoma of the pancreas received an extended pancreatectomy, in which a wide range of lymphatic and connective tissue clearance was performed in addition to the conventional pancreatectomy, at Osaka Medical Center for Cancer and Cardiovascular Diseases. All patients were followed-up to determine whether and where cancer recurrence developed. RESULTS: Excluding 4 patients who died of postoperative complications, our liver perfusion chemotherapy was performed on 27 patients. The other 67 patients did not receive this treatment. In the group that underwent liver perfusion chemotherapy, no patients experienced complications such as leucocytopenia (< 3000/mm3), thrombocytopenia (< 50,000/mm3), or liver disfunction. The cumulative survival rate differed remarkably between the two groups: 92% vs 62% at one year (p < 0.05); 51% vs 35% at three years (p < 0.05); and 41% vs 25% at five years (ns). CONCLUSIONS: When this method was performed after an extended pancreatectomy for adenocarcinoma of the pancreas, our preliminary report (Am J Surg. 1994; 168:361-364) indicated that it was useful not only for preventing hepatic metastasis, but also for improving patients' survival rate. Since then, further positive and supportive results have been obtained in an additional investigation.