[Surgical resection of exocrine neoplasms of the pancreatic head: indications and requirements].
Surgical resection is the only curative procedure for the treatment of the cancer of the pancreatic head: this paper describes the precise indications for surgery. These are: tumour size (diameter less than 4 cm), no metastases in the extra regional lymph nodes, no arterial invasion or involvement of the portal vein of more than 1.2 cm in length or its bilateral narrowing. The authors point out that only the complete removal of the retropancreatic tissue allows control of local recurrence and metastasis. They examine different resective procedures, concluding, on the basis of the literature and their own experience, that R2 subtotal pancreatoduodenectomy leads to a curative resection because of the removal of the foci of micrometastasis, a better control of local recurrence and, perhaps, a longer survival. They discuss the problem of the use of pyloro preserving pancreatic duodenectomy (PPDP) for exocrine tumours of the pancreas and conclude that it is correct to perform such an operation even for the treatment of these tumours if the local extension of the neoplasm allows it. Finally, the authors underline the need to use other adjuvant therapies to improve results: these however, are very often, quite limited.
Gazzaniga
G M
GM
I Divisione Chirurgia Generale, Ospedale S. Martino, Genova.
Castagnola
M
M
Pastorino
G
G
D006801:Humans; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*
La chirurgia resettiva nelle neoplasie esocrine della testa del pancreas: indicazioni e presupposti.