Indications and techniques of extended resection for pancreatic cancer.
BACKGROUND
The resectability rate and postoperative survival rate for pancreatic carcinoma are poor. Aggressive resection including vascular resection and extended lymphadenectomy represent one strategy for improving survival. This study was carried out to clarify the indications for extended resection, especially vascular resection, for pancreatic carcinoma.


METHODS
From July 1981 to March 2005, we performed curative resection in 289 of 443 patients with pancreatic carcinoma in our department (65.2%). Vascular resection was performed in 201 (69.5%) patients and portal vein resection without arterial resection in 186 patients. Combined portal and arterial resection was performed in 14 patients and arterial resection without portal vein resection in 1. Extended lymphadenectomy including paraaortic lymph nodes was done. The postoperative survival rate was stratified according to operative and pathology findings.


RESULTS
Operative mortality (any death within 30 days after surgery) occurred in 11 of the 289 curative resection patients (3.8%), including 1 of 88 patients without vascular resection (1.1%), 5 of 186 portal vein resection patients without arterial resection (2.7%), and 5 of 14 (35.7%) arterial resection patients undergoing portal vein arterial resection as well. Most patients who survived for 2 to 3 years had carcinoma-free surgical margins.


CONCLUSIONS
The most important indication for vascular resection in patients with pancreatic cancer is the ability to obtain cancer-free surgical margins. Otherwise, vascular resection is contraindicated. Extended lymphadenectomy may be not of benefit.
Nakao
Akimasa
A
Department of Surgery II, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. nakaoaki@med.nagoya-u.ac.jp
Takeda
Shin
S
Inoue
Soichiro
S
Nomoto
Shuji
S
Kanazumi
Naohito
N
Sugimoto
Hiroyuki
H
Fujii
Tsutomu
T
D000714:Anastomosis, Surgical; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery*; D002445:Celiac Artery / Q000601:surgery; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D017538:Mesenteric Artery, Superior / Q000601:surgery; D008642:Mesenteric Veins / Q000601:surgery; D010179:Pancreas / Q000098:blood supply; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011169:Portal Vein / Q000601:surgery; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000379:methods