An Evaluation of Extended Pancreatectomy for Adenocarcinoma of the Pancreas from the Viewpoint of Curability and Postoperative Quality of Life

Hiroaki Ohigashi, Osamu Ishikawa, Yo Sasaki, Kouhei Murata, Takushi Yasuda, Masao Kameyama, Masahiro Hiratsuka, Toshiyuki Kabuto, Hiroshi Furukawa and Shingi Imaoka

Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases

In order to eradicate locoregional recurrence after pancreatectomy for adenocarcinoma of the pancreas, we have widened the range of lymphatic and connective tissue clearance (from D1 to D2α). As a result, the 5-year survival rate improved from 9% to 29% for stage III-cancer and from 0% to 3% for stage IV-cancer. When at least one posive node was detected, no long-term survivors were obtained by the D1-procedure, but were found by the D2α -procedure. When liver perfusion chemotherapy was added to the D2α -procedure, the 5-year survival rate for stage IV-cancer improved to 20%, because of a decrease in the incidence of hepatic recurrence. For t3-cancer, no 5-year survivors were found in the D2α -group, however, two patients (22%) were found in the group of D2α+liver perfusion chemotherapy. Among 33 patients who survived more than three years without cancer recurrence after D2α-procedure, weight loss and severe diarrhea were the main causes that lowered patients' QOL. However, these patients were convinced that they would recover their health within 2 years after the D2α-procedure. Thus, the D2α-procedure in combination with liver perfusion chemotherapy should be more frequently performed for n1-/t2-cancers. On the other hand, for more advanced cancers such as n2-/t3-cancers, D2α-procedure should not be performed without using adjuvant therapies which are effective in preventing both hepatic metastasis and local recurrence.

Key words
quality of life in long-term survivors, extended pancreatectomy, perioperative adjuvant treatment

Reprint requests
Hiroaki Ohigashi Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511 JAPAN

Accepted
January 27, 1999

To read the PDF file you will need Abobe Reader installed on your computer.