A Comparison of Distal Pancreatectomy and the Cancreas-preserving Operation for Advanced Gastric Cancer in Regard to the Quality of Life of the Patients and the Treatment Results

Taira Kinoshita, Keiichi Maruyama, Mitsuru Sasako, Shigekazu Ooyama

Department of Surgery, National Cancer Center Hospital

From 1977 to 1990, 233 patients received distal pancreatectomy (DP) and 137 received a pancreas-preserving operation with removal of the splenic artery (PP) for advanced gastric cancer without leaving a tumor mass, at the National Cancer Center Hospital. The 5-year survival rate for the DP group (33.9%) was significantly lower than the 58.1% for the PP group. Concerning the cancer stage, the 5-year survival rate for the PP group was better than for the DP group in stage I, II and III. The 5-year survival rates for the patients with one or more positive lymphnodes around the splenic artery were 10.1% for the DP group (n=59) and 16.8% for the PP group (n=14). The incidence of hospital death and complications was higher in the DP group than in the PP group. Results of the oral glucose tolerance test revealed better glucose tolerance in the PP group than in the DP group. Thirteen patients in the DP group (5.6%) but none in the PP group required further treatment for diabetes mellitus. These data suggest that the pancreaspreserving operation is effective for selected patients who need prophylactic lymph node dissection around the splenic artery, and gives the patients better quality of life than distal pancreatectomy.

Key words
lymphnode dissection aroud the splenic artery for advanced gastric cancer, distal pancreatosplenectomy, quality of life

Reprint requests
Taira Kinoshita Department of Surgery, National Cancer Center Hospital
5-1-1 Tsukiji, Chuo-ku, Tokyo, 104 JAPAN

Accepted
July 6, 1992

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