Pancreatic cancer.

INTRODUCTION

Pancreatic cancer is the fourth most common cause of cancer death in higher-income countries, with 5-year survival only 5% even in people presenting with early-stage cancer. Risk factors include smoking, high alcohol intake, and dietary factors, while diabetes mellitus and previous pancreatitis may also increase the risk.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of surgical treatments in people with pancreatic cancer that is considered suitable for complete tumour resection? What are the effects of adjuvant treatments in people with completely resected pancreatic cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 31 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: chemoradiotherapy for resected pancreatic cancer, chemoradiotherapy, fibrin glue, fluorouracil-based chemotherapy (adjuvant) for resected pancreatic cancer (with or without surgery), fluorouracil-based chemotherapy (systemic), fluorouracil-based chemotherapy for non-resectable pancreatic cancer, fluorouracil-based combination chemotherapy, fluorouracil-based monotherapy for non-resectable pancreatic cancer, gemcitabine-based chemotherapy (adjuvant) for resected pancreatic cancer, gemcitabine-based chemotherapy (systemic), gemcitabine-based combination chemotherapy, gemcitabine-based monotherapy for non-resectable pancreatic cancer, lymphadenectomy (extended [radical], or standard) in people receiving pancreaticoduodenectomy, pancreatic duct occlusion, pancreaticoduodenectomy (pylorus-preserving), pancreaticoduodenectomy (Whipple's procedure), pancreaticogastrostomy reconstruction, pancreaticojejunostomy, pylorus-preserving pancreaticoduodenectomy, and somatostatin and somatostatin analogues.