Importance of extended radical resection for treatment of pancreatic head cancer

Abstract

Objective To investigate the importance of extended lymphadenectomy and retro-peritoneal soft tissue clearance for the patients with ductal adenocarcinoma of the pancreas,and mor-bidity,mortality and survival of patients with ductal adenocarcinoma of the pancreas receiving pancrea-tectomy with en bloc portal vein resection. Methods The clinical data of 56 patients with ductal ade-nocarcinoma of the pancreas undergoing extended radical resection in our hospital between 2001 and 2004 were retrospectively analyzed. In addition, they were categorized into two groups according to whether there were positive lymph nodes: group A (n=40) of positive lymph nodes and group B (n=16) of negative lymph nodes. They were also categorized into two groups according to whether there was combined superior mesenteric-portal vein(SMPV) resection: group Ⅰ (n = 39) of no combined SMPV resection and group Ⅱ (n= 17) of combined SMPV resection. Results The morbidity and mor-tality of the 56 patients were 30% and 2%, respectively. The overall 1-, 3-and 5-year survival rates were 63%, 29% and 16%, respectively. Postoperative pathological examination found 40 cases (71%)of positive lymph node. Of those 11 cases of paraaortic lymph node involvement, 16 (29%) were of negative lymph node. There were no significant difference in 1-,3-and 5-year survival rates between group A and B,while the survival curve for those with paraaortic lymph node involvement was signifi-cantly worse than group A and B. The combined SMPV resection was performed in 17 cases, no signif-icant differences in 1-,3-and 5-year survival rates between group Ⅰ and Ⅱ were found. The mean surviv-al of patients with microscopically positive margin (n = 5) was only 9 months as compared with 23months in those with microscopically negative margin (n= 51). Conclusion If selected carefully, ex-tended lymphadenectomy and retroperitoneal soft tissue clearance combined with SMPV resection canbe performed safely. Extended radical resection will be benefit to some patients with positive lymphnode, but can not increase the survival rate of patients with positive paraaortic lymph node. SMPV re-section should be performed only when a margin-negative resection is expected to be achieved. SMPV invasion are not associated with histological parameters suggesting a poor prognosis. Key words: Pancreatic neoplasms; Pancreaticoduodenectomy; Extended lymphadenectomy; Superior mesenteric-portal vein resection