Strategy for Invasive Ductal Carcinoma of the Pancreatic Head Based on Clinicopathological Features, Operative Method and Post-operative Status

Hodaka Amano, Tadahiro Takada, Hideki Yasuda and Masahiro Yoshida

First Department of Surgery, Teikyo University School of Medicine

Extended pancreatoduodenectomy, to remove a wide range of lymph nodes and nerve plexus, has been widely applied in pancreatic head cancer in Japan. However, long-term survivors were rare in advanced cases who frequently underwent non-curative resection and even aggressive extended operations. In addition, patients' quality of life (QOL) became worse by extended operation. Because curative resection may result in longer survival eventhough QOL may worser, candidates for extended operation should be carefully selected. In this study, 872 cases of pancreatoduodenectomy were analyzed. As tomor extended to large vessels and nerve plexus, the survival rate statistically declined. However in some cases with portal vein invasion, portal vein resection may prolong survival. There were statistical differences in the survival rate between the degree of lymph node dissection, D₀ to D₂, for n₁ cases. The survival rate after pylorus-preserving pancreatoduodenectomy (PPPD) was statistically better than after Whipple procedure. However there were no statistically significant differences in patients' backgrounds between these two groups. Furthermore, postoperative QOL after PPPD was better than after Whipple procedure. There fore, our preferred strategy for pancreatic head cancer is to perform extended PPPD, to remove a wide range of lymph nodes and nerve plexus, and to resect the portal vein in cases of portal vein invasion, to obtain curative resection.

Key words
invasive ductal carcinoma of the head of the pancreas, extended pancreatoduodenectomy, pylorus-preserving pancreatoduodenectomy

Reprint requests
Hodaka Amano First Department of Surgery, Teikyo University School of Medicine 2-11-1 Kaga-cho, Itabashi-ku, Tokyo, 173-8605 JAPAN

Accepted
January 27, 1999

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