Extended Resections of Ductal Pancreatic Cancer – Impact on Operative Risk and Prognosis

Abstract

114 patients received a standard and 75 patients an extended resection of ductal pancreatic carcinoma at the Hanover Medical School, Germany, from 1971 until 1993. Standard pancreatic resections were combined with vascular resection and reconstruction in 46 and additional organ resections in 45 cases. Vascular resections affected the mesentericoportal vein in 37, the common hepatic in 10 and the superior mesenteric artery in 7 cases. Pancreas resections were combined with total gastrectomy in 23, partial colectomy in 17, hemihepatectomy in 14, adrenalectomy in 8 and nephrectomy in 5 patients. Curative resections could be accomplished in 86% of patients without and 81% with extended resections. Additional vascular resections neither increased the operative risk nor deteriorated the long-term prognosis after resection. Additional organ resections, however, significantly increased the risk of lethality and impaired the long-term prognosis. Especially resections of synchronous hepatic metastases and colectomies were associated with a poor survival probability.

Is the need for an arterial resection a contraindication to pancreatic resection for locally advanced pancreatic adenocarcinoma? a case‐matched controlled study

“…Inability to separate the pancreatic adenocarcinoma from the SM-PV trunk or the SMAwas historically considered as a contraindication for resection in adenocarcinoma of the pancreas. This view was sustained by the early experience with radical regional pancreatectomy (Fortner Type II operation), which resulted in high mortality and morbidity rates [3,19,20]. Failure to improve survival as well as high complications rates dissuaded surgeons to follow such aggressive approaches [20][21][22][23].…”

Reconstruction of visceral arteries with homografts in excision of the pancreas

“…Ebenso beeinträchtigt die Venenresektion nicht das Patientenüberle-ben nach Pankreasresektion. Oft wird die Notwendigkeit einer Veneresektion erst in der letzten Phase der Pankreasresektion offensichtlich, sodass eigentlich jeder Chirurg, der Pankreasresektionen durchführt, mit der Technik der Venenrekonstruktion im Pfortadergebiet vertraut sein sollte [4,19,22]. Eine partielle Venenwandinfiltration ohne Verschluss wird dabei mehr als ein technisches Problem der Resektion betrachtet, ist aber nicht mit einer schlechteren Prognose vergesellschaftet [4].…”

Extended Resection for Pancreatic Adenocarcinoma

“…There are no prospective randomized trials comparing pancreatectomy with and without VnR. Most retrospective studies demonstrate that while VnR is associated with longer operative times and larger blood loss, the morbidity and mortality of pancreatectomy with VnR is similar to those of pancreatectomy alone (Table 3) [42][43][44][45][46][47][48][49][50][51][52][53][54]. There was a high incidence of venous invasion (50%-82%) among patients who underwent VnR.…”