Results of Resection for Pancreatoduodenal Carcinoma: Mode of Tumor Spread and Factors Influencing Survival

Shuji Isaji, Naoki Ohashi, Takashi Kurumiya, Kikuhiro Nakamura, Toshio Yamamoto, Yoshifumi Ogura, Takashi Noguchi, Yoshifumi Kawarada, Ryuji Mizumoto

First Department of Surgery, Mie University School of Medicine

The mode of tumor spread and factors influencing survival were analyzed in 93 patients with resection for pancreatoduodenal carcinoma, including 71 pancreaticoduodenectomies and 22 total pancreatectomies. 1) Resectability: 53.3% in 92 surgical patients with carcinoma of the pancreatic head, 92.9% in 28 patients with carcinoma of the papilla of Vater, 86.7% in 15 patients with carcinoma of the lower bile duct, and 100% in 5 patients with carcinoma of the duoenum. 2) Prognosis: The cumulative 5-year survival rate was 52.0% in carcinoma of the papilla of Vater, 38.0% in carcinoma of the lower bile duct, 25.0% in carcinoma of the duodenum, and 6.8% in carcinoma of the pancreatic head. 3) Mode of tumor spread: The incidence of lymph node involvement was 80.0% in carcinoma of the duodenum, 73.5% in carcinoma of the pancreatic head, 34.6% in carcinoma of the papilla of Vater, and 30.8% in carcinoma of the lower bile duct. The incidence of venous and perineural invasions was more than 60% in carcinoma of the pancreatic head and the duodenum, but it was less than 50% in carcinoma of the papilla of Vater and the lower bile duct. 4) Factors influencing survival: Venous and perineural invasions were highly associated with poor prognosis in pancreatoduodenal carcinoma. Other important factors were pancreatic capsular and portal vein invasions in carcinoma of the pancreatic head, pancreatic parenchymal invasion in carcinoma of the papilla of Vater, and duodenal invasion in carcinoma of the lower bile duct. All patients with survival of more than 3 years had well differentiated tubular adenocarcinoma.

Key words
carcinoma of the pancreatic head, carcinoma of the periampullary region, operative results of the pancreatic duodenal carcinoma , mode of tumor spread of the pancreatic duodenal carcinoma, factors influencing survival of the pancreatic duodenal carcinoma

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

Accepted
October 11, 1989

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