title: Long-term survivors after resection of carcinoma of the head of the pancreas: significance of histologically curative resection.
abstract: OBJECTIVE
  The prognosis of patients with pancreatic cancer is said to have not been improved markedly by any procedures in the past 20 years. Since 1973, we have gradually extended the area of dissection when performing curative resection for pancreatic cancer to improve the resection rate and prognosis. Nineteen patients have survived for 3 years or more, and the 5-year survival rates of patients with cancer of the head of the pancreas were 23.9% for macroscopically curative resection and 34.3% for histologically curative resection.
  
  
  METHODS
  We histologically observed surgical specimens, cut into 3- to 5-mm sections and compared the histologic characteristics of the 19 patients who survived for 3 years or more with those of 41 patients who died of cancer within 3 years (excluding 6 operative and hospital deaths), in order to find the conditions required for long-term survival.
  
  
  RESULTS
  The following conditions were associated with long-term survival: (1) tumor diameter 3 cm or less; (2) either absence of lymph node metastasis or metastasis limited to the n(1) group; (3) degree of invasion of the anterior pancreatic capsule of zero (s0); and (4) either no retropancreatic invasion (rp0) or exposed retropancreatic invasion (rpe) with no cancer invasion of dissected peripancreatic tissue ew(-).
  
  
  CONCLUSIONS
  At present, because the rpe rate is more than 70%, resection of the pancreas, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection, because the retropancreatic tissue between the back of the pancreas and this fascia is anatomically considered to be in the position of the subserosal tissue in the gallbladder or stomach. Combined resection of the superior mesenteric artery may further improve the results of resection for pancreatic cancer, from the anatomical viewpoint.
authors.affiliation: School of Health Sciences, Faculty of Medicine, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan.
authors.forename: Takukazu
authors.initials: T
authors.lastname: Nagakawa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
authors.forename: Michiko
authors.initials: M
authors.lastname: Inagaki
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ueno
authors.forename: Ichiro
authors.initials: I
authors.lastname: Konishi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kitagawa
mesh_terms: D004210:Dissection; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors