title: Mono-bloc total spleno-pancreaticoduodenectomy for pancreatic head carcinoma with portal-mesenteric venous invasion. A prospective randomized study.
abstract: 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.
authors.affiliation: Department of Surgical Oncology, Henry Dunant Hospital, Athens, Greece. iasg@iasg.org
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: Gurusharan
authors.initials: G
authors.lastname: Singh
authors.forename: E
authors.initials: E
authors.lastname: Bardaxoglou
authors.forename: G
authors.initials: G
authors.lastname: Dedemadi
authors.forename: G
authors.initials: G
authors.lastname: Sgourakis
authors.forename: J
authors.initials: J
authors.lastname: Nestoridis
authors.forename: A
authors.initials: A
authors.lastname: Malliotakis
authors.forename: M
authors.initials: M
authors.lastname: Pedonomou
authors.forename: E K
authors.initials: EK
authors.lastname: Solomou
authors.forename: M
authors.initials: M
authors.lastname: Safioleas
authors.forename: Maria
authors.initials: M
authors.lastname: Alamani
authors.forename: L
authors.initials: L
authors.lastname: Grigorakos
authors.forename: E M
authors.initials: EM
authors.lastname: Merikas
mesh_terms: 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