1997 Volume 30 Issue 10 Pages 2064-2068
In the present study, appropriate surgical margin of the tumor and adequate area forlymphadenectomy was evaluated in 527 patients with periampullary cancer who received radical operation. For the patients with invasive ductal adenocarcinoma of the pancreatic head, extended radical operation including extended lymphadenectomy, extrapancreatic nerve dissection and portal vein resection was thought to be necessary. Since the outcome of extended radical operation for patients with highly advanced cancer was extremely poor, extended operation should not be indicated for these patients. In order to improve the operative results, extended operation should be applied for patients with Clinical Stage III (RP2, PV2, A (-)) or below determined by using preoperative or intraoperative imaging techniques for tumor extent. For the patients with carcinoma of the duodenal papilla, dissection of lymph nodes along the superior mesenteric artery or vein (No.14) carried survival benefit, and for the patients with distal bile duct cancer, adequate resection of bile duct and dissection of retroperitoneal tissue contributed to the prognosis. Retrospective study on pancreaticoduodenectomy for periampullary cancer showed that if there are no findings of direct invasion to the duodenal bulb or the gastric antrum, lymph node metastasis surrounding stomach (No.3, 4, 5, 6, 7) is rare. Therefore pylorusf preserving pancreaticoduodenectomy can be indicated to more than 90% of the patients with periampullary cancer without reducing curability.
