Pancreaticoduodenectomy for locally advanced stomach cancer: preliminary results.
BACKGROUND
Pancreaticoduodenectomy (PD) for locally advanced stomach cancer involving duodenum or/and pancreatic head was controversial and rarely carried out. It was mainly reported from the Japanese institutions.


METHODS
A review of prospective database from January 2003 to December 2006 of patients who had locally advanced stomach cancer involving duodenum or/and head of pancreas that precluded curative subtotal gastrectomy who underwent diagnostic laparoscopy or exploratory laparotomy to exclude peritoneal metastatic disease. Patients were advised to undergo neoadjuvant chemotherapy before PD.


RESULTS
Seven patients underwent PD during the above-mentioned period. Only four patients had neoadjuvant chemotherapy before PD. The median operative time was 8 h (range 6-9 h). Five patients had combined tranverse colectomy done. There was no 30-day operative mortality or re-operation. Three patients developed controlled pancreatic leaks and fistulas that were successfully treated with conservative measures. The length of hospital stay was 10-53 days (median 15 days). Median survival was 13 months and 2-year survival rate was 60%. Patients who received neoadjuvant chemotherapy seemed to have better survival rate (P = 0.039).


CONCLUSIONS
Our initial experience has shown that with careful and stringent patients selection, PD for locally advanced stomach cancer can be carried out with acceptable morbidity and mortality. Early results for patients who received neoadjuvant chemotherapy showed trend towards prolonged survival. However, longer follow up and further patient recruitment are needed to confirm our initial optimistic findings.
Chan
Weng-Hoong
WH
General Surgery, Singapore General Hospital, Singapore. gsucwh@sgh.com.sg
Cheow
Peng-Chung
PC
Chung
Alexander Y F
AY
Ong
Hock-Soo
HS
Koong
Heng-Nung
HN
Wong
Wai-Keong
WK
D004379:Duodenal Neoplasms / Q000556:secondary / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000556:secondary / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome