Extended Pancreatectomy for the Pancreatic Cancer

Abstract

Adenocarcinoma of the pancreas is commonly observed to spread into the peripancreatic connective tissues by microscopic examination, which may explain the high incidence of loco-regional recurrence after conventional pancreatectomy. Thus, using a wide range of lymphatic and connective tissue clearance (extended pancreatectomy), we have succeeded in both improving the long-term survival rate (5-yrsurvival rate=27%) and significantly decreasing loco-regional recurrence. In contrast to conventional pancreatectomy, long-term survivors were obtaiend even amongst patients with nodalinvolvement or invasion to the portal vein. However, for tumors of more than 4 cm in size, with nodal involvement in the n2-group and extensive invasion to the portal vein long-term survival was not expected. Most patients who had received this procedure took at least one year to fully recover. Thus, the present paper outlines the surgical techniques in extended pancreatectomy that we employ, and it is concluded that the careful selection of cases for this aggressive surgery is most important.