SEOUL NATIONAL UNIVERSITY HOSPITAL

 The research team of Professors composed of Sun-Whe Kim, Jin-Young Jang, Mee Joo Kang at the Department of Surgery at Seoul National University Hospital (SNUH) has proposed the standard surgery method that enhances the survival rate of pancreatic cancer patients by conducting the clinical trial with largest cohort until now.

Pancreatic cancer is the 9th highest in its occurrence among Koreans, 5th highest in its mortality rate, and its 5-year survival rate is mere 7.8%; thus, the prognosis of pancreatic cancer is very poor. In order to cure the disease, surgical removal is vital. However, the method of surgery has been the area of contention among academics.

 The pancreatic cancer cells spread through lymph nodes and nerve tissue that are close to pancreas. Thus, some physicians have resected a wide area of lymph nodes and nerve plexus near pancreas in order to increase the survival rate; however, it created complications such as intractable diarrhea and malnutrition, which lowered the life quality of patients.
Until now, the standard for surgical resection area for pancreatic cancer had not existed; therefore, the operative outcome and complications differed largely depending on the hospital or physician.

  The team’s clinical trial took place from 2006 to 2010 and involved 169 pancreatic patients who were scheduled to receive pancreaticoduodenectomy in 7 domestic hospitals. The patient group was prospectively divided into standard lymphadenectomy/nerve plexus dissection group (comparison group, 83 patients) and extended lymphadenectomy/nerve plexus dissection group (control group, 86 patients) and overall survival rate was compared between the two groups.
 The pancreaticoduodenectomy is one of the most complicated surgery among abdominal operations, and it resects pancreas, duodenum, and biliary tract together. Standard lymphadenectomy only removes specific lymph nodes that are in close proximity to pancreas and prone to metastasis of cancer, while extended lymphadenectomy resects larger area of lymph nodes than standard lymphadenectomy, and also removes nearby nerve plexus tissues as well.

  The analysis result revealed that the 2-year survival rate after the pancreatic cancer operation was 44.5% in comparison group while the control group showed 35.7%. Also, the 2-year progression-free survival rate of comparison group was 25.2% while the control group showed 19%. In other words, no evidence was found that extended lymphadenectomy increases the survival rate of cancer patients. However, postoperative complications were found to increase slightly after extended lymphadenectomy.

The research team reported that the survival rate is increased through the postoperative chemotherapy and radiation therapy. The median value of survival period of patients who received chemoradiotherapy was 20.8 months while that of patients who did not receive such therapy was 14 months.   In particular, the 2-year survival rate of patients in the comparison group who received chemoradiotherapy was 50.7% while that of patients who did not receive the therapy was 25%.

 The research team stated that “this research revealed that standard lymphadenectomy can achieve the same level of operative outcome as extended lymphadenectomy, and this can now prevent extended lymphadenectomy that accompanies complications such as intractable diarrhea and malnutrition, which lower the quality of life.”

   In additional comments, the team stated that “in consideration of the fact that active postoperative chemoradiotherapy enhances the survival rate, the most appropriate therapy for pancreatic cancer as of now is to actively conduct chemoradiation therapy after the standard operation.”

  The research result was published during International Association of Pancreatology and other domestic and international prominent academic associations, and it put an end to the existing controversy in the academia regarding the extent of pancreatic surgery.

 This research was recently published in “Annals of Surgery”, which is the most prestigious academic journal in surgical department. The Department of Surgery of SNUH conducted the pancreaticoduodenectomy for the first time in Korea in 1961, and the total number of pancreatectomy exceeded 3,000 in 2013, which placed them at the 5th place in the global ranking as a single institution.

The long-term survival rate after receiving pancreaticoduodenectomy from SNUH is at the same level as the Johns Hopkins Hospital, which is known to be one of the world’s best. The immediate postoperative death rate is 0.3%, which is lower than the Johns Hopkins Hospital’s rate of 1.6%. Additionally, it was reported that the cure rate of bile duct cancer, of which surgery method is also a pancreaticoduodenectomy, is higher than that of the Johns Hopkins Hospital by more than 1.5-2 times, and this is a testament to Korea’s world top level of treatment result for pancreatic and biliary tract cancer. End.