Clinicopathologic Study of Carcinoma of the Pancreas Head Based on its Recurrence

Masato Kayahara, Takukazu Nagakawa, Keiichi Ueno, Tetsuo Ohta, Kazuhiro Mori, Tatsuo Nakano, Toshiya Takeda, Itsuo Miyazaki

The Second Department of Surgery, Kanazawa University, School of Medicine

Ninety-two patients with carcinoma of the pancreas hed lesion who had undergone macroscopically curative resections were analyzed regarding the mode of recurrence. Retroperitoneal local recurrence including neural, lymphatic invasion, and/or para-aortic nodal involvement was the most frequent. Postoperative radiographic examinations revealed hepatic metastasis in 2 patients, retroperitoneal recurrence in 12, and both in 10. The frequency of recurrence in patients with Stage I, II was statistically lower than that in Stage III, IV patients. Recurrence in the patients with distal bile duct cancer was seen when carcinoma cells invaded the pancreas tissue. The main sites of recurrence for those patients were hepatojejunostomy, or the para-aortic region. In patients with carcinoma of the papilla of Vater, hepatic metastasis and local recurrence were equally observed. These results indicate that local recurrence was one of the most important problems and radical dissection including para-aortic lymph nodes and extrapancreatic plexus was necessary for carcinoma of the head of the pancreas. It is important to perform the pancreatectomy with nodal resection around the superior mesenteric artery for the patients with distal bile duct cancer and carcinoma of the papilla of Vater.

Key words
mode of recurrence, pancreatobiliary cancer, local recurrence

Reprint requests
Masato Kayahara Second Department of Surgery, Kanazawa University School of Medicine
13-1 Takaramachi, Kanazawa, 920 JAPAN

Accepted
December 9, 1992

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