Indication and Limits of Extended Surgery for Invasive Ductal Carcinoma of the Pancreas

Shuji Isaji, Tatsushi Naganuma and Yoshifumi Kawarada

First Department of Surgery, Mie University School of Medicine

Results of extended resection for invasive ductal carcinoma of the pancreas were assessed to determine its indication and limits. From September 1979 to August 1998, 84 (48.8%) of 172 surgical patients underwent resection. The cases were divided as follows: 34 cases in the early period (through April 1981) , which were treated by pancreatic resection limited to D1 lymph node dissection; 100 cases in the middle period (May 1991 through March 1993), which were treated by extended surgery and included either D2 lymph node dissection or combined resection of the portal vein; and 38 cases in the late period (April 1993 through August 1998), in which indication of resection included consideration of curability and patient QOL. The resection rate was 32.4% in the early period, which was significantly lower than 54.0% and 50.0%, respectively, in the middle and late periods. Curative resection rates were significantly higher in the middle (68.5%) and late periods (63.2%) than in the early period. The 3-year survival rates improved, from 9.1% in the early period, to 18.1%in the middle period and to 36.4% in the late period. For stage IV cancer, however, patients in whom extended resections proved to be noncurative had extremely poor prognosis, and showed very poor QOL and similar survival results to those who received palliative bypass surgery. Extended surgery should not be employed in all cases with advanced pancreatic cancer, and bypass procedures should be selected for cases in which curative resection is considered to be impossible.

Key words
extended operation, palliative operation, biliary bypass with antrectomy or gastric partition

Reprint requests
Shuji Isaji First Department of Surgery, Mie University School of Medicine 2-174 Edobashi, Tsu, 514-8507 JAPAN

Accepted
January 27, 1999

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