Strategy of Surgical Management for Invasive Ductal Adenocarcinoma of the Pancreas by Clincal Analysis of the Long-term Survivors

Abstract

We examined 46 patients who had resection for invasive ductal adenocarcinoma of the pancreas. Of these 17 survived more than 5 years after operation, and 29 died due to tumor recurrence within a year after operation. In patients without tumor invasion to the retroperitoneal tissue (rp), D₁+α lymphadenectomy with dissection of the retroperitoneal nerve plexus was performed in most cases, but no tumor invasion to the extrapancreatic nerve plexus was found. The incidence of lymph node metastasis was significantly lower in longterm survivors, 33%, Liver metastasis was most frequently observed in patients dead by tumor recurrence, 75%.In patients with rp, either D₁+α or D₂ lymphadenectomy with dissection of the retroperitoneal nerve plexus was performed. In long-term survivors with up, the incidence of lymph node metastasis was significantly lower, 38%, Liver metastasis and retroperitoneal recurrence were 68% and 40%, respectively, in patients dead by tumor recurrence. Quality of life (QOL) was poor in patients dead by tumor recurrence. In conclusion to increase the number of long-term survivors of invasive ductal adenocarcinoma of the pancreas, D₁+α lymphadenectomy and other effective measures to inhibit liver metastasis are necessary in patients without rp, further more, D₂ lymphadenectomy with dissection of the retroperitoneal nerve plexus and other effective measures to inhibit local recurrence and liver metastasis are necessary in patients with rp.