A Study on Recurrent Pattern after Extended Surgery for Pancreatic Cancer -Including the Effect of Intraoperative Radiation Therapy-

Tetsuya Kaneko, Akimasa Nakao, Akio Harada, Toshiaki Nonami, Hiroshi Takagi

Department of Surgery II, Nagoya University School of Medicine

Forty-four cases, in which a recurrent pattern of pancreatic cancer was demonstrated by autopsy or imaging diagnosis were reviewed. Four patient who died within 30 days after surgery and on whom autopsies were performed were also reviewed. Extended pancreatic resection was performed from July 1981 to September 1992 in 106 patients. The patterns of recurrence were divided into local recurrence, distant metastasis and peritoneal dissemination. The local recurrence rate was 38.6%. The local recurrence rate for patients in whom intraoperative radiotherapy (IORT) was performed was 31%. The rate for patients in whom IORT was not performed was 50%. IORT suppressed local recurrence but not sufficiently. Expansion of the field of IORT and combination with postoperative external radiotherapy should be considered. In patients with distant metastasis, liver metastasis was demonstrated in 79.5%. No relationship was found between liver metastasis and portal venous invasion. Moreover, there was no demonstrable relationship between liver metastasis and venous invasion. According to histological findings of the tumor, the rate of liver metastasis was significantly low in papillary adenocarcinoma. Peritoneal dissemination was demonstrated in 29.5% of the patients. The rate of peritoneal dissemination increased as the degree of serosal invasion, became more severe. In the group with no serosal invation, IORT seemed to suppress peritoneal dissemination.

Key words
recurrence pattern of pancreatic cancer, extended resection for pancreatic cancer, intraoperative radiation therapy

Reprint requests
Tetsuya Kaneko Department of Surgery II, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
June 14, 1993

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