Evaluation of the Extended Radical Operation and Intraoperative Radiation Therapy for the Cancer of the Head of the Pancreas -Aspects of Mode of Extension and Recurrence-

Toshihide Imaizumi, Toshiaki Nakasako, Nobuhiko Harada, Takashi Hatori, Akira Fukuda, Shigeru Munakata, Fumiaki Ozawa, Fujio Hanyu

Department of Gastroenterological Surgery, Tokyo Women's Medical College

During the past 26 years, we have resected 282 ductal adenocarcinomas of the head of the pancreas. Ninety-three percent of the cases showed invasion to the extra-pancreatic tissues, and86% were in stage III or IV. Curability by extended radical surgery was increased to 49% from 26% by the standard operation. Postoperative morbidity and mortality were l9%, and 4%. One, 3-and 5-year-old survival rates were 44%, 13%, and 9%. Five-year-survivors included 10 patients curatively resected by the extended radical surgery. The extended radical surgery was significant in improving survival time. The site of recurrence was the retroperitoneum in 63% of cases and the liver in 46%. Since 1988 we have selected the indications for extended radical surgery by using the preoperative diagnostic techniques. The patients who have severe invasion to the major vessels and/or retroperitoneum are not indicated for extended radical surgery. Intraoperative radiation therapy (IORT) for patients with resected ductal adenocarcinoma of the head of the pancreas was not so effective in terms of survival time and recurrence of the carcinoma in the protocol of the last 8 years. The selection of IORT is indicated for patients who are curatively resected by extended radical surgery.

Key words
ductal adenocarcinoma of the pancreas, extended radical operation for cancer of the pancreas, intraoperative radiation therapy for cancer of the pancreas

Reprint requests
Toshihide Imaizumi Department of Gastroenterological Surgery, Tokyo Women's Medical College
8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 JAPAN

Accepted
July 6, 1994

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