Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas

Abstract

Seventy-four patients were treated with a radical or a nonradical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Their survival rates and the selection of the operative procedure were evaluated. In 32 patients, a radical pancreatectomy was attempted where there was sufficient clearance of regional or juxta-regional lymph nodes beyond the group of suspected metastatic nodes, as well as a resection of a greater margin of soft tissue around the pancreas. These patients' cumulative 5-year survival rate was 33.4%. In 14 Stage I or Stage 11 patients, the cumulative 5-year survival rate was 46.4%. In 18 Stage 111 or Stage IV patients, the cumulative 5-year survival rate was 20.7%. For 42 patients treated with a nonradical pancreatectomy with the dissection of lymph nodes adjacent to the pancreas or of regional lymph nodes but with insufficient clearance of the soft tissue around the pancreas, the cumulative 2-year and 3-year survival rates were 5.4% and 0%, respectively. In seven patients with Stage I1 carcinoma, the survival rate was 16.7% after 2 years and 0% after three years. In 35 Stage I11 or Stage IV patients, the survival rate was 3.2% after 2 years and 0% after 3 years. Thus, the survival rates were significantly higher in patients treated with radical operation than in patients who had nonradical operation. These results indicate that a radical pancreatectomy with sufficient lymph node clearance with the surrounding connective tissue around the pancreas is indispensable to cure patients with ductal cell carcinoma of the pancreas. Cancer 64:1132-1137. 1989. ESPITE the development of new diagnostic aids such D as ultrasonography, computerized tomography, en-doscopic retrograde pancreatocholangiography, and an-giography, the prognosis for patients with pancreatic car-cinoma, particularly pancreatic ductal cell carcinoma, is poor because of the tumor's low resectability and a limited postoperative survival time when compared with other gastrointestinal malignant neoplasms. In most cases, tumors extend to the outer margin of the pancreas and infiltrate the pancreatic capsule and adjacent vessels. ',* Even if these lesions appear to be resected in the course of pan-createctomy, they are often overlooked since invisible microscopic lesions may be left behind. Therefore, the primary lesion should be removed with as much surrounding, apparently noncancerous tissues as is feasible, including an en bloc removal of the regional From the First

Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry

“…In many studies involving extensive surgery, the prognosis did not seem to be substantially influenced or improved. [1][2][3][4][5][6] The reported values on long time survivors of PDAC have been questioned and it has been claimed that they are markedly lower than reported. While five year survival rates of 30-55% in PDAC patients treated with a curative intent have been published, [7][8][9][10][11] reports of actual five year survival have usually been more modest, (approximately 10-20% for patients undergoing curative resection).…”

Chirurgische Standardtherapie beim Pankreaskarzinom

“…So liegen die 5-JahresÜberlebensraten nach Resektion beim Pankreaskarzinom bei ca. 10-20%, wobei die publizierten Zahlen zwischen 0,4 und 33% schwanken [15,30]. Weltweit haben sich in der chirurgischen Behandlung des Pankreaskarzinoms einige Standards durchgesetzt; es gibt jedoch immer noch eine Reihe von international kontrovers diskutiert Fragen, wie z.…”

Mixed Osteoclastic and Pleomorphic Giant Cell Carcinoma of the Pancreas

“…12 Neoplasms of pancreatic head and ampullary region are generally treated with pancreaticoduodenectomy (Whipple operation), the alternative being total pancreatectomy. 13 Mortality from these operations has decreased from 20% to 2% in specialized centers in recent years.…”