Surgical Approach for Radical Dissection Around the Superior Mesenteric Artery for Carcinoma of the Pancreatic Head Area Based on the Pattern of Tumor Spread and Mode of Recurrence

Masato Kayahara, Takukazu Nagakawa, Hajime Arakawa, Haruo Yagi, Fumio Futagami, Masanori Nagamori, Hirohisa Kitagawa, Tetsuo Ohta, Keiichi Ueno, Itsuo Miyazaki

The Second Department of Surgery, Kanazawa University School of Medicine

The pattern of tumor spread and mode of recurrence of carcinoma of the pancreatic head area were investigated by clinicopathologic analysis for the preservation of superior mesenteric pleuxus. One hundred and thirty three patients with carcinoma of the pancreatic head area were examined histopathologically. These patients consisted of 70 with carcinoma of the head of the pancreas (Ph), 3l with distal bile duct cancer (Bi), and 32 with carcinoma of the papilla of Vater (A). Fifty-five (79%) of the patients with "PH" disease, 21 (67%) of those with "Bi" disease, and 14 (44%) of those with "A" disease had nodal involvement. Frequencies of No. 14 lymph node metastasis were 34%, 32%, and 16%, respectively. Extrapancreatic plexus invasion by these three carcinomas was observed in 60% of "Ph", 26% of "Bi", and 3% of "A" patients. Retroperitoneal recurrence including paraaortic lymph nodes was discovered in 88% of the patients with "Ph" who had undergone macroscopically curative resection. A1l six "Bi" patients with recurrence among patients who underwent curative resection had retroperitoneal recurrence. These results indicate that complete dissection including paraaortic lymph nodes and the extrapancreatic plexus is necessary for carcinoma of the head of the pancreas. It is possible to perform nodal dissection around the supperior mesenteric artery while preserving the nerve plexus for patients without far advanced distal bile duct cancer or carcinoma of the papilla of vater.

Key words
pattern of tumor spread for carcinoma of pancreatic head area, mode of recurrence, redical dissection without nerve plexus resection

Reprint requests
Masato Kayahara Second Department of Surgeyr, Kanazawa University School of Medicine
13-1 Takaramachi, Kanazawa, 920 JAPAN

Accepted
December 6, 1995

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