Extensive resection in pancreatic cancer: review of the literature and personal experience.
OBJECTIVE
The surgical treatment of pancreatic carcinoma, and particularly the decision to resect locally advanced non-metastatic cancer is extremely controversial. The aim of this study is to report our experience in extensive pancreatectomy and draw conclusions regarding its effectiveness in treating locally advanced pancreatic cancer.


METHODS
In our Department of Surgery, 12 patients underwent pancreatic resective surgery extended to the portal vein (6 cases), to the superior mesenteric vein (1 case) or to other peripancreatic organs (5 cases).


RESULTS
The procedure was considered curative in 7 cases. The mortality rate was 16.6% and the morbidity 25%. Four out of the five patients who had undergone vascular resection and had not died in the postoperative period survived for more than 12 months, while the 5 cases in whom the resection was extended to other organs survived from 9 to 93 months. In all cases, the quality of life was satisfactory until tumor recurrence, which occurred in 8 cases (66.7%). Two of the cases with vascular resection are still alive after 17 and 22 months.


CONCLUSIONS
In all of these 12 cases, we were forced to perform "extensive" resective surgery, which was apparently curative, although we were not able to prevent recurrence in a high percentage of cases. Moreover, aggressive surgery seems justified in particular histotypes, such as in the carcinoid case reported in our study; debulking enhances the effectiveness of chemotherapy and permits relief of the endocrine symptoms eventually induced by the tumor.
Civello
I M
IM
Department of Surgery, Catholic University School of Medicine, Rome, Italy.
Frontera
D
D
Viola
G
G
Cina
G
G
Sganga
G
G
Crucitti
F
F
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life