An Evaluation of Extended Pancreatectomy with Resecting Pylorus Alone for Advanced Adenocarcinoma of the Pancreas

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

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

In resecting pancreatic cancer, the 5-year survival rate was improved from 11 to 29% in stage III and from 0 to 3% in stage IV, by extending the range of lymphatic and connective tissue clearance (D2α). Long-term survivors were obtained from the patients in the t2-subgroup regardless of the nodal involvement, however there was no 5-year survivor who had received D2α in the t3-subgroup. Liver perfusion chemotherapy via both portal vein and hepatic artery (2-channel treatment) significantly decreased the incidence of liver metastasis, resulting in a 25% 5-year survival rate for the t3-subgroup patients. Micrometastasis was examined in the peripyloric lymph node and surrounding connective tissues by histologic, cytologic and genetic (k-ras point mutation by MASA method) examinations. As a result, microinvasion was positive in two out of 15 patients by histologic examination alone, and in other three cases by cytologic or genetic examination. In order to erradicate the possible cancer cells aroud the pylorus and improve the patient's QOL, we performed pylorus resecting PD (PrPD) which preserved nearly entire stomach. In comparison with conventional PD, PrPD showed a smaller loss of body weight and earlier recovery. This result seemed to be supported by our isotopic analysis where the PrPD showed a longer gastric emptying speed than conventional PD. From these results, it is concluded that we need some adjuvant therapies, like 2-channel treatment, in addition to an extended pancreatectomy if we intend to resect advanced pancreatic cancer (t3). Likewise, the PrPD would be helpful in improving the patient's QOL after pancreatoduodenectomy without escalating the chance of local recurrence.

Key words
extended pancreatectomy, pylorus resecting PD, microinvasion on peripyloric region

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
July 28, 1999

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