Adjuvant Therapy for Surgically Resected Pancreatic Adenocarcinoma

In 2008, approximately 37 000 patients will be diagnosed with pancreatic adenocarcinoma in the United States, and most of these patients will succumb to this disease within the first year following diagnosis.¹ Only approximately 7400 patients will have localized cancer, usually involving the head of the pancreas, and are candidates for surgery if the tumor is resectable, as defined by the absence of vascular involvement.² Such patients are candidates for complete resection of the primary cancer. The prognostic significance of an incomplete resection is well-defined (ie, the survival duration of those who undergo an incomplete [R1] resection is on average shorter than that of patients achieving a complete [R0] resection and in some series is no different than the survival of patients with locally advanced stage III disease who receive chemoradiation without surgery, chemotherapy, or both).^3- 4 With optimal patient selection, improved surgical techniques, and modern perioperative care, many patients who undergo pancreatic resection will recover adequately to become candidates for postoperative adjuvant therapy and this, coupled with the high frequency of cancer recurrence following surgery, provides a strong impetus to offer such therapy to patients.