Results of adjuvant therapy in resected pancreatic cancer.

After an apparently curative resection, most patients develop local recurrence within the resection bed. In addition, almost all develop liver metastases. This implies that the surgical resection, even if extended, seldom is enough, and that an adjuvant treatment must be effective not only against systemic spread, but also against local recurrence. However, the time schedule may be different for different types of recurrence, resulting in different time frames for the adjuvant treatment. Although extended radical operations may increase the proportion of patients who can undergo resections, the incidence of local recurrences seems unchanged. There are, however, no randomized studies yet comparing the "Standard Whipple" with more extended resection. Intraoperative radiation (IORT) has failed to demonstrate a difference in long-term survival, but there have been reports of a decreased frequency of local progression at the site of the primary tumor. Therefore, it is encouraging that IORT seems to diminish the local recurrences after radical resections. However, randomized studies are also missing for this procedure. These are today only three published studies of adjuvant chemotherapy after radical pancreaticoduodenectomy, but a few more will be finished shortly. Still, the results have not convincingly shown that modern chemotherapy with or without radiotherapy prolongs the life of the patients, and there is little evidence for improving the quality of life. However, since the results are far from satisfactory after resection, more efforts should be made to find better treatment modalities, including adjuvant protocols.