It is suggested that the incidence of DGE after SSPPD can be decreased by using B-II rather than R-Y reconstruction for gastrojejunostomy.(Clinical Trials Registry, UMIN-CTR: http://www.umin.ac.jp/ctr/, ref no. UMIN000003535).

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Background: We analyzed the outcome of patients with advanced unresectable pancreatic cancer treated in our department from 2001 to 2008. Methods: Of the 83 patients included in this study, 50 patients received single-agent treatment with gemcitabine (GEM), 9 patients GEM combined with radiotherapy (GEM+R) and 24 patients had best supportive care (BSC). We analyzed survival rates among the groups and risk factors for each group. Results: The 3-year survival rates were dismal: GEM group 2.9%, GEM+R group 0% and BSC group 0%. Significant prognostic factors of the study were: performance status (PS), response rate and decrease in the CA19-9 level. Significant prognostic factors by the Cox proportional hazard model were the albumin level prior to treatment, CA19-9 levels before treatment, decrease in CA19-9 and response rate. Albumin levels and the Glasgow Prognostic Score (GPS) were found to be factors affecting survival in the GEM group. Conclusion: In this series of patients with unresectable pancreatic cancer, good PS, decrease in CA19-9 after treatment and good GPS determined prior to treatment were independent prognostic factors for better overall survival.

Overall, S-1 did not improve DFS compared with gemcitabine after pancreatic cancer resection, but there seemed to be a DFS advantage in patients with low expression of DPD or high expression of TS. Reference number: UMIN000009118 (http://www.umin.ac.jp/ctr/).