Indications of an Extended Radical Operation for the Carcinoma of the Head of the Pancreas

Toshihide Imaizumi, Mamoru Suzuki, Toshiaki Nakasako, Hideki Matsuyama, Nobuhiko Harada, Eiji Komatsu, Takeshi Kimura, Takashi Hatori, Tetsuya Hirose, Toshio Arai, Fujio Hanyu

Department of Gastroenterological Surgery, Tokyo Women's Medical College

The aim of this study was to establish appropriate indications for extended radical pancreatecotmy in patients with carcinoma of the head of the pancreas on the basis of a preoperative diagnosis of tumor extension and the curability rate. Seventy-five patients with ductal adenocarcinoma of the head of the pancreas in whom CT scan and abdominal angiography were performed preoperatively were selected for this study. The accuracy of preoperative diagnosis of arterial invasion (A) by CT scan and angiography was 92.0%, and it was 49.4%, 62.7%, 58.7%, and 61.3% of portal (PV), retroperitoneal (Rp), plexuses (Plx), and serosal invasion (S), respectively. Preoperative diagnosis was more difficult in patients who had mildly extended tumors than in patients who had no tumor extension or severely extended tumor. Curability was 65.1% in patients with A₀, 46.4-86.4% in PV_0∼2, 50.0-100% in Rp_0∼2, whereas it was 0-16.7% in A₃, PV₃, or Rp₃. The curability rate was so low in patients with severe extension of the tumor that extended radical pancreatectomy was not considered the treatment of choice. Although preoperative diagnosis was not easy in patients with mildly extended tumor, extended radical surgery is indicated to obtain a curative operation.

Key words
pancreatic cancer, extended operation for the cancer of the head of the pancreas, preoperative diagnostic evaluation of the cancer of the head of the pancreas

Reprint requests
Toshihide Imaizumi Department of Gastroenterological Surgery, Tokyo women's Medical College
8-1 Kawadacho, Shinjuku, Tokyo, 162 JAPAN

Accepted
November 20, 1991

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