Curative Surgery for Carcinoma of the Head of the Pancreas

Itsuo Miyazaki

Second Department of Surgery, Kanazawa University School of Medicine

The clinical significance of radical surgery for carcinoma of the head of the pancreas was reviewed from the standpoint of neural invasion. Since 1973 extended radical pancreatectomy has been performed for pancreatic cancer in our institute on the basis of clinicopathologic study. Pancreatectomy by a translateral retroperitoneal approach was developed in 1977 . Based on the three-dimensional analysis, the main mode of tumor invasion was neutral invasion around the superior mesenteric artery. Desmoplastic cancer infiltration was observed mainly around the portal vein and inferior vena cava. A detailed chinicopathologic study of carcinoma of the head of the pancreas indicated that it is necessary to perform complete dissection of the extrapancreatic plexus around the superior mesenteric artery, including extensive lymph node dissection of the superior mesenteric nodes and para-aortic lymph nodes. The mechanism of neural invasion of pancreatic cancer, modes of tumor spread, and the correlation between neural invasion and other clinicopathologic factors were reviewed. Three-dimensional studies of the retroperitoneal invasion by pancreatic cancer were reviewed on the basis of complete histologic serial section analyses. The main mode of tumor invasion was neural invasion around the superior mesenteric artery. These findings suggest that it is necessary to perform complete resection of extrapancreatic plexus.

Key words
pancreatic cancer, radical resection, neural invasion, plexus invasion, retropreitoneal invasion

Reprint requests
Itsuo Miyazai Second Department of Surgery, Kanazawa University School of Medicine
13-1 Takara-machi, Kanazawa, 920 JAPAN

Accepted
November 15, 1995

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