Surgical resection of potentially curable pancreatic cancer with improved preservation of endocrine function--further evaluation of intraoperative cytodiagnosis.
Very early detection of pancreas cancer is most desirable, since it permits less invasive surgery which has a correspondingly greater chance of success. The present study investigated both surgical outcome and postsurgical quality of life in 8 patients whose occult neoplasms were successfully treated. In all 8 patients, cytology of the pancreatic secretion obtained during endoscopic retrograde pancreatography (ERP) was positive, although no pancreatic tumor was detected by ERP, other examinations or intraoperative inspection. In these 8 patients, our method of intraoperative cytodiagnosis to locate occult neoplasms of the pancreas (Surgery 1992; 111: 294-300) was used (1). Using this method of cytodiagnosis, we were able to avoid total pancreatectomy in 6 patients (75%; 3 pancreatoduodenectomies and 3 caudal pancreatectomies), but not in the other 2 patients. Histopathological study of the resected specimens indicated that the extent of pancreatic resection was quite appropriate in all 8 patients. There were 6 minimally invasive carcinomas, one carcinoma in situ and one borderline lesion. Neither nodal involvement nor severe invasion was found on microscopic inspection, and all have been disease-free for 23 +/- 13 months after surgery. In the 6 patients with partial pancreatectomies, both postoperative quality of life and general health were good, with no insulin-dependent diabetes developing. Thus, our cytology-guided surgical technique is very useful not only for locating occult and potentially curable neoplasms, but also for avoiding blind resection of the entire pancreas, permitting better preservation of pancreatic endocrine function.
Ishikawa
O
O
Department of Surgery, Center for Adult Diseases, Osaka, Japan.
Ohigashi
H
H
Nakaizumi
A
A
Uehara
H
H
Kitamura
T
T
Takenaka
A
A
Sasaki
Y
Y
Imaoka
S
S
D000368:Aged; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome