Mono-bloc total spleno-pancreaticoduodenectomy for pancreatic head carcinoma with portal-mesenteric venous invasion. A prospective randomized study.
OBJECTIVE
To evaluate, the early and long-term results of mono-bloc spleno-pancreatic and vascular resection for advanced carcinoma of the head of the pancreas, with portal-mesenteric venous invasion.


METHODS
In a prospective, randomized trial, fifty-six patients with advanced carcinoma of the head of the pancreas with vascular invasion were studied. Patients were randomly divided in two groups A and B. Group A patients underwent an en-bloc spleno-pancreatic and vascular resection. Group B patients underwent a palliative gastro-biliary bypass. Patients in both groups were subjected to adjuvant locoregional chemoimmunotherapy, through an arterial catheter introduced into the superior mesenteric artery via a jejunal arterial branch.


RESULTS
The 2- and 5-year survival rates for Group A patients were 81.8% and 18.5%. The respective percentages for disease-free survival were 60.6% and 0%. Two-year survival for group B was nil.


CONCLUSIONS
Mono-bloc spleno-pancreaticoduodenectomy and regional vascular resection and reconstruction, with adjuvant locoregional chemoimmunotherapy leads to substantial prolongation of survival and optimization of quality of life.
Lygidakis
N J
NJ
Department of Surgical Oncology, Henry Dunant Hospital, Athens, Greece. iasg@iasg.org
Singh
Gurusharan
G
Bardaxoglou
E
E
Dedemadi
G
G
Sgourakis
G
G
Nestoridis
J
J
Malliotakis
A
A
Pedonomou
M
M
Solomou
E K
EK
Safioleas
M
M
Alamani
Maria
M
Grigorakos
L
L
Merikas
E M
EM
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D008642:Mesenteric Veins / Q000473:pathology; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000473:pathology; D011446:Prospective Studies; D011788:Quality of Life; D013156:Splenectomy