Adenosquamous carcinoma of the pancreas: a single-institution experience comparing resection and palliative care.

BACKGROUND: Adenosquamous carcinoma is a rare malignancy of the exocrine pancreas. Previous literature has reported dismal survival for these patients. We examined our single-institution experience with this tumor to compare survival for sugical resection and palliative therapy.

STUDY DESIGN: Records were reviewed for patients with adenosquamous pancreatic cancer evaluated during the years 1985 to 2003. Pathology specimens were reviewed. Survival was calculated by Kaplan-Meier method and categorical variables were compared with Chi-square analysis. A p value < 0.05 was considered significant.

RESULTS: Twenty-three patients were identified with adenosquamous carcinoma of the pancreas. Twelve patients underwent curative resection and 11 patients had either no surgery or a palliative bypass procedure. For the resection group the mean age was 69 years (7 men). In the nonoperative group the mean age was 65 years (6 men). Operative procedures included standard pancreaticoduodenectomy (PD), 4 patients; pyloruspreserving PD, 3 patients; and distal pancreatectomy, 5 patients. Median length of stay was 13.5 days (7-30 d). Morbidity included delayed gastric emptying (4 patients), leak (2 patients), superficial skin infection, abscess, and GI bleed (1 patient each). There was no operative or inhospital mortality in the resection group. For R0 resection median survival was 14.4 months compared to 8 months for R1 and 4.8 months for patients undergoing palliative therapies.

CONCLUSIONS: The retrospective review of our single-institution experience with resection and palliative care for adenosquamous cancer of the pancreas has demonstrated a longer survival for patients that can undergo an R0 resection. Although this is a small series we continue to recommend resection for these patients.