Is Pylorus-preserving Pancreatico-duodenectomy an Adequate Operation for Stage IVa Cancer of the Head of the Pancreas?

Sonshin Takao, Hiroyuki Shinchi and Takashi Aikou

First Department of Surgery, Kagoshima University School of Medicine

The indication of pylorus-preserving pancreaticoduodenectomy (PpPD) for stage IVa cancer was investigated using an analysis of 83 patients with invasive ductal adenocarcinoma of the head of the pancreas who underwent surgery between 1980 and 1997. In the cumulative survival curves of overall or stage IVa cancer, there was no significant difference among pancreaticoduodenectomy (PD), PpPD, and total pancreatectomy (TP). In patients with stage IVa cancer, the cumulative 5-year survival rate was only 3%, although the conclusive curabilities of PD, PpPD, and TP, were 58%, 75%, and 55%, respectively. In patients with retroperitoneal or neural plexus invasion, the cumulative survival curves showed no significant difference among PD, PpPD, and TP. The important point to notice is that PpPD was not performed for the patients with invasion of the serosa of the pancreas. The recurrent rates and the modes of recurrence after PD and PpPD were almost similar. Although the extended operation was effective inprevently locoregional recurrence, it had no impact on the survival rate because of liver metastases. These results indicate that PpPD with extended lymphadenectomy and dissection of the retroperitoneal tissues and neural plexus can provide the conclusive curability, quality of life, and an effective strategy for liver metastases for the patients with stage IVa cancer. Therefore, the PpPD is an appropriate operation for the patients with stage IVa cancer of the head of the pancreas except for these cases involving invasion of the serosa of the pancreas.

Key words
invasive ductal adenocarcinoma of the head of the pancreas, pylorus-preserving pancreaticoduodenectomy, Stage IVa pancreatic cancer

Reprint requests
Sonshin Takao First Department of Surgery, Kagoshima University School of Medicine 8-35-1 Sakuragaoka, Kagoshima, 890-8520 JAPAN

Accepted
July 28, 1999

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