Resection for adenocarcinoma of the body and tail of the pancreas

Abstract

Adenocarcinoma of the pancreatic body and tail often presents late and is widely regarded as incurable by surgical resection; long-term survivors are rare. Thirteen patients underwent left resection (n = 7) or total pancreatectomy (n = 6) in a consecutive series of 105 patients with carcinoma of the body or tail of the pancreas. Comparison was made with 17 patients with locally advanced or metastatic disease. Preoperative computed tomography predicted irresectable disease when a large perivascular lymph node mass was demonstrated. Preoperative angiography predicted irresectable disease when there was encasement or obliteration of the coeliac axis or its major branches, or of the superior mesenteric artery or vein. Splenic vessel involvement was sometimes compatible with resection. After resection, median survival was 13 (range 3-50) months, with a minimum follow-up of 2 years. Five patients survived more than 2 years, and three are still alive 30, 43 and 50 months after resection. Resection of carcinoma of the body or tail of the pancreas was possible in 12 per cent of patients and long-term survival was observed in some of these.

Results of radical distal pancreatectomy with en bloc resection of the celiac artery for locally advanced cancer of the pancreatic body

“…The long-term results of radical distal pancreatectomy with en bloc resection of the celiac artery, with 1-and 2-year survival rates of 51% and 14% and the median survival of 12.2 months are not satisfactory, although they are significantly better than those of palliative surgery and are similar to reported survival in less advanced tumors [1][2][3][4]6,7,18]. The fact that the majority of treatment failures were due to hepatic metastases indicates a need for more effective adjuvant therapy against hepatic metastases.…”

“…However, the operation provided a high resectability rate (20/30: 67%) and was locally curative, generating clear surgical margins (R0 resection) in all patients. Consequently only one patient developed retroperitoneal recurrence, even though all patients had large tumors involving the celiac and common hepatic arteries and complained of intractable abdominal and/or back pain preoperatively, which have been considered indicators of unresectability by most centers [2,3,8].…”

“…Even without involvement of the great arteries, extrapancreatic extension for pancreatic cancer often results in local recurrence after curative pancreatectomy [2,6,18]. One of the most important etiologic factors is perineural invasion in the neural plexus surrounding the great arteries [22].…”

“…Most of cancers of the body and tail of the pancreas are discovered at a far advanced stage due to the lack of any specific signs or symptoms, such as obstructive jaundice caused by cancers of the head of the pancreas, and curative resection rates remain less than 22% [1][2][3][4][5][6][7][8]. Especially in cancers of the body of the pancreas, extrapancreatic extension often involves the celiac artery and/or the common hepatic artery, which are anatomically contiguous with the body of the pancreas.…”

“…Especially in cancers of the body of the pancreas, extrapancreatic extension often involves the celiac artery and/or the common hepatic artery, which are anatomically contiguous with the body of the pancreas. This situation forces the surgeon to declare the lesion unresectable in spite of the absence of distant metastasis [2,3,8]. Since Nimura et al's report [9], however, several authors have performed a radical distal pancreatectomy with en bloc resection of the celiac and common hepatic arteries for these locally advanced cancers [4,[10][11][12][13].…”