Pancreas Invasion Research Articles

Predictors and Recurrence Patterns After Radical Surgery in Ampulla of Vater Cancer: Comparative Analysis Between Early and Late Recurrence

ObjectiveTumor recurrence remains the main dilemma after surgical treatment of ampulla of Vater carcinoma. This study was designed to identify the prognostic factors and evaluate the recurrence patterns of ampulla of Vater cancer.MethodsA total of 286 patients who underwent surgical resection of ampulla of Vater cancer in two medical centers from January 2000 to October 2016 were collected. Data on clinicopathologic factors, survival rate, and recurrence patterns were retrospectively analyzed.ResultsA total of 158 patients (55.2%) survived without evidence of recurrence (non-recurrence), whereas 65 (22.7%) and 63 patients (22.1%) suffered from recurrence of the disease within 12 months (early recurrence) and after 12 months (late recurrence), respectively. Early-recurrence patients exhibited a more advanced disease (advanced tumor stage, lymph node involvement, pancreas invasion, and late TNM stage) than late-recurrence patients. The first or primary location of cancer recurrence in 33 patients (25.8%) was locoregional. Metastasis developed in the liver in 30 patients (23.4%), peritoneum in 13 patients (10.2%), lungs in 10 patients (7.8%), and para-aortic or superior mesenteric artery lymph node in 10 patients (7.8%). Multiple metastases were observed in 26 patients (20.3%).ConclusionThe most common patterns of postoperative recurrence are locoregional and recurrent liver metastasis. The recurrence patterns with the worst prognosis are peritoneal and multiple metastases.

Results of sımultaneous pancreas resectıon after neoadjuvant chemotherapy in local advenced gastric cancers

Standard treatment in gastric cancer gained a new dimension after contributions from South Korea and Japanese groups. Advanced stage non metastatic gastric cancer which was accepted as an inoperability criteria before 2000s, can nowadays be accepted as resectable due to advancements in neoadjuvant chemotherapy and aggressive surgical methods. In this study, we aim to analyze the results of simultaneous pancreas resection in patients with T4b tumor with adjacent organ invasion. Local advanced gastric cancer cases which were collected prospectively between 2016 to 2020 were analyzed. Among 70 patients with local advanced gastric cancer, 14 of them with simultaneous pancreas invasion were separated and evaluated on the basis of demographic data, postoperative complications, neoadjuvant chemotherapy modalities. Among 70 patients which were operated between years 2016 to 2020 due to local advanced gastric cancer, 14 of them had pancreas invasion. Average age of these 14 patients was 58 (46 to 72), male/female ratio was: 5/9. Among these, whipple was performed in 4 (28.57%), subtotal pancreatectomy was performed in 5 (35.71%) and distal pancreatectomy was performed in 5 (35.71%) in addition to total gastrectomy and D2 lenf dissection. Splenectomy was performed simultaneously in 8 cases of subtotal and distal pancreatectomy. Mean operation time forall 14 caseswas 317 ± 33 minutes. When postoperative complications were analyzed, 2 cases had biliary leakage, 2 cases. We think that simultaneous resection of pancreas in local advanced gastric cancers can be performed in surgical oncology clinics with contributions of experienced hepatobiliary surgeons with acceptable morbidity and mortality rate.

Prognostic factors and patterns of recurrence after curative resection for patients with distal cholangiocarcinoma

Background and purposeThis study aimed to determine the prognostic factors and generate an atlas of a distribution of locoregional recurrence (LRR) in patients with distal cholangiocarcinoma (DCCA), after pancreatoduodenectomy (PD) without adjuvant radiotherapy. Materials and methods124 DCCA cases registered in our institutional database from 2006 to 2018 were analyzed retrospectively. The Cox proportional hazards model was used for multivariable analysis. All recurrence sites were centrally reviewed, and LRRs were plotted on one CT scan of a template that represents the relapse pattern of the patients. ResultsThe median follow-up time was 35.3 months (95% CI 22.1–48.5 months). Independent prognostic factor for locoregional recurrence-free survival was lymph node metastasis (p = 0.014). Older age, pancreas invasion, and lymph node metastasis were associated with poor survival (both p < 0.05). During the follow-up period, 69 patients (55.6%) developed disease progression. Among them, 45 patients (65.2%) had recurrence in the locoregional components. 21 patients (30.4%) were diagnosed with liver metastasis. Of the patients with LRR, most recurrences occurred in the nodes along the superior mesenteric artery (36.2%), nodes around the abdominal aorta (26.1%), nodes in the hepatoduodenal ligament (13.0%), nodes around the celiac artery (10.1%), and anastomotic stoma (10.1%). ConclusionThe high-risk sites of LRR after PD for primary DCCA are the nodes along the superior mesenteric artery, abdominal aorta, nodes in the hepatoduodenal ligament, nodes around the celiac artery, and anastomotic stoma. Adjuvant radiation should cover these areas to improve locoregional control for these patients.

Computed tomography features of gastric cancer invasion to the pancreas and significance in the assessment of resectability of primary lesions

Computed tomography features of gastric cancer invasion to the pancreas and significance in the assessment of resectability of primary lesions

Carbonic Anhydrase IX Expression is Associated with Favorable Prognostic Factors in Small Intestinal Carcinoma

Tumor hypoxia is associated with more aggressive behavior and resistance to chemotherapy and radiotherapy. Carbonic anhydrase IX (CA9) level increases under hypoxia and is related to poor prognostic factors. The aim of this study was to evaluate the expression of CA9 and to identify its prognostic significance in small intestinal carcinomas (SICs). CA9 expression was observed in 36% (63/175) of SICs. CA9 expression showed significant correlation with well- and moderately differentiated tumors compared with poorly differentiated tumors (p=0.039), tumors with no lymph node metastasis (p=0.005), and lower stage carcinomas (p=0.009). CA9 expression showed an inverse correlation with perineural invasion (p=0.021) and lymphatic invasion (p=0.022). No significant correlation was observed between CA9 expression and gross type, histological type, pathological tumor (pT) classification, vascular invasion, pancreas invasion, and retroperitoneal seeding. SICs with CA9 overexpression showed better overall survival compared with those with no or weak CA9 expression (p=0.048). In the multivariate analysis, poorly differentiated SICs (p<0.001) and SICs with lymph node metastasis (p=0.002) were independent poor prognostic factors. CA9 expression in SICs is more frequently associated with good prognostic markers and better overall survival; however, it is not an independent prognostic factor.

Pancreas-sparing duodenectomy for an obstructive adenocarcinoma of the duodenum.

A duodenal adenocarcinoma arising from the junction of the second and third portion of the duodenum, which was resected by pancreas-sparing duodenectomy, is reported. The completely obstructing tumour was circumferential and measured 6.5cm x 3.5cm x 1.0 cm. There was no evidence of pancreas invasion, nor any lymph node metastasis. Pancreas-sparing duodenectomy was performed, with dissection of the pancreaticoduodenal lymph nodes. The proximal duodenum was transected just distal to the ampula of Vater and jejunum was transected just distal to the ligament of Treitz. A hand-sewn side-to-side anastomosis for the duodenojejunostomy was performed. There were no postoperative complications. Pathology reported a duodenal adenocarcinoma resected with negative margins. Pancreaticoduodenectomy is the treatment of choice for a duodenal adenocarcinoma, however, pancreas-sparing duodenectomy may be a safe alternative for duodenal tumours not involving the 2nd portion, especially in elderly patients with multiple medical comorbidities.

Surgical Indications for Gastrectomy Combined with Distal or Partial Pancreatectomy in Patients with Gastric Cancer

The purpose of this study was to clarify the surgical indications for gastrectomy combined with distal or partial pancreatectomy (GP) in patients with gastric cancer. From January 1994 to December 2009, 29 patients with primary gastric cancer surgically invading the pancreas without distant organ metastasis underwent GP for R0 resection. The patients' characteristics, surgical data, and clinicopathological features were used for the analysis of survival and prognostic factors. The median disease-free survival and median survival time (MST) of all patients were 15 and 30 months, respectively. Only pN3 status (characterized by 7 or more pathologically metastatic lymph nodes) according to the Japanese Classification of Gastric Carcinoma, 14th edition, was shown to be a prognostic factor in a multivariate analysis. The MST of the patients with pN3 and the other patients were 12 and 51 months, respectively (p < 0.001). We suggest that pancreas invasion should not be considered a contraindication for gastrectomy and that patients with a small number of lymph node metastases (six or fewer) might be candidates for GP in the case of gastric cancer that requires pancreatectomy for R0 resection.

Expression of hMLH1, hMSH2 and hMSH6 in Small Intestinal Carcinomas

Although primary small intestinal carcinoma (SIC) is morphologically similar to colorectal carcinoma and shares many of the genetic changes of carcinogenesis, little is known about the role of defective mismatch repair (MMR) genes involved in the SIC. The aim of this study is to investigate the role of defective MMR genes and correlation between clinicopathological factors and loss of MMR protein in SIC. A total of 195 SIC cases were collected from 20 institutions in Korea and tissue microarrays (TMA) were made. The loss of expression of hMLH1, hMSH2 and hMSH6 was examined by immunohistochemistry (IHC). The loss of expression of hMLH1, hMSH2 and hMSH6 was identified in 25/193 (13.0%), 25/193 (13%) and 29/195 (15%), respectively. The loss of hMSH2 expression was associated with retroperitoneal seeding. Patients with loss of hMSH6 expression had a tendency to invade deeply and a higher frequency of pancreas invasion. The loss of hMSH6 expression was associated less frequently with peritumoral adenoma. There was no survival difference by MMR protein expression status. The loss of MMR protein was associated with some distinct clinicopathological features. MMR pathway seems to be major pathway in carcinogenesis of SICs. MMR defect seems to be related with sporadic-microsatellite instability (MSI).

Surgical Impact on Gastric Cancer with Locoregional Invasion

The benefit of resection of gastric cancer with locoregional invasion is still under debate. This study aimed to investigate the impact of surgery on patients with gastric cancer with locoregional invasion. From January 1988 to December 2009, a total of 2,678 patients with gastric cancer underwent surgery at the Department of Surgery, Taipei Veterans General Hospital. Among these patients, 569 and 295 were diagnosed as T4a (serosa invasion without penetration of visceral peritoneum) and T4b (serosa exposure with invasion of adjacent structure), respectively. Invasion type and prognosis were analyzed in patients with gastric cancer who had either curative or palliative resection. Our results showed that patients with T4a gastric cancer had a better 5-year overall survival than patients with T4b (22.5% vs. 11.5%, P<0.001). Patients with T4b who had curative resection had a better 5-year overall survival than those with T4b who had palliative resection (13.8% vs. 7.3%, P=0.001). The prognosis of patients with gastric cancer with pancreas invasion was worse than those with mesocolon invasion, as no patients with pancreas invasion survived more than 5years. Univariate and multivariate analyses showed that tumor size (P=0.019), Bormann classification (P<0.001), stromal reaction (P=0.001), and nodal involvement (P<0.001) were independent predictors for overall survival in patients with T4b gastric cancer. Resection of T4b gastric cancer could be performed with curative intent. Patients with gastric cancer with pancreas invasion had a poorer prognosis than those with mesocolon invasion.

Prognostic value of duodenal invasion length in patients with gastric cancer.

24 Background: Duodenal invasion (DI) has been considered as a poor prognostic factor of gastric cancer patients. Not all the patients would be able to undergo curative operation. Neoadjuvant chemotherapy (NAC) may improve the rate of curative operation of these patients. In this study, we investigated whether the length of duodenal invasion preoperative diagnosis can be one of factor to decide indication of NAC. Methods: A total of 118 gastric cancer patients with clinically evident DI, who underwent laparotomy at our center, were enrolled in this study. 42 patients with DI length 20 mm or longer were categorized into long invasion group (LI), 76 patients with DI length shorter than 20 mm were categorized into short invasion group (SI). Clinicopathologic features, rate of direct invasion and lymph nodes involvement, R0 resection, and survival rate were compared between two groups. Results: Resection rate was significantly different between two groups: SI group (85.5%; 65/76), LI group (69.0%; 29/42). Direct invasion to adjacent organs was significantly more frequently observed in LI group (21%; 6/29) than SI group (4 %; 3/65, p = 0.02). In LI group, pancreas invasion was observed in all patients except for one patient. Multivariate analysis to predict the adjacent organ invasion revealed that CT diagnosis (p = 0.005) and invasion length (p = 0.01) were selected as risk factors of direct invasion to adjacent organs. There was no significant difference of nodal involvement between LI group (83%; 24/29) and SI group (83%; 54/65 p = 0.99). The 5-year survival rate was 19% in LI group and 43% in SI group (p = 0.23). The number of patients who underwent R0 resection was more frequently in SI group (75.4%; 49/65) than SI group (69.1%; 16/29). The factors of R1 or R2 resection were metastasis of peritoneum or direct invasion to adjacent organs. Conclusions: In patients with long duodenal invasion, direct invasion to the pancreas was more frequently observed, and resulted in low curative resection rate and poor survival. Preoperative chemotherapy may improve the curative resection rate and survival in these patients. Prospective study is warranted to evaluate the efficacy of NAC for these patients. No significant financial relationships to disclose.

Abstract 377: Inhibition of c-Met and VEGFR by XL184 reduces tumor invasiveness and metastasis and prolongs survival of RIP-Tag2 transgenic mice

Abstract Recent studies have shown that inhibition of VEGF signaling can promote tumor invasiveness and metastasis in some preclinical models. The mechanism underlying the increased aggressiveness is not fully understood but activation of the hepatocyte growth factor/c-Met pathway may be a factor. We addressed this mechanism by determining whether inhibition of VEGFR and c-Met together can reduce tumor growth and invasiveness and improve host survival. Our approach was to compare the effects of a tyrosine kinase inhibitor, XL184 (BMS-907351), which blocks VEGFR and c-Met, with the effects of an antibody that selectively blocks mouse VEGF. After treatment of pancreatic islet cell tumors in 14-week-old RIP-Tag2 mice withanti-mouse VEGF antibody for 3 weeks, the tumors were smaller (tumor area 4.3 ± 0.8 mm2 in antibody group versus 17.3 ± 6.5 mm2 in vehicle group, P &amp;lt; 0.05) but had greater expression of c-Met. Tumors treated with anti-VEGF antibody also had more irregular borders, indicative of invasion of the surrounding acinar pancreas (invasion index 18.9 versus 12.7 in vehicle group, P &amp;lt; 0.05), and more abundant liver metastases (metastases 2.73 ± 1.83 /mm2 versus 0.45 ± 0.12 /mm2 in vehicle group, P &amp;lt; 0.05). By comparison, mice treated with XL184 not only had smaller tumors (tumor area 0.7 ± 0.1 mm2, P &amp;lt; 0.05) than in the other groups but also had less invasive tumors (invasion index 4.5, P &amp;lt; 0.05), and lacked liver metastases. All mice treated with XL184 from 14 weeks of age survived until 20 weeks (n = 6), but none treated with vehicle (n = 14) or anti-VEGF antibody (n = 8) reached that end point. These results show that selective inactivation of VEGF reduces tumor growth but leads to greater invasiveness and metastasis in the RIP-Tag2 model. However, inhibition of VEGFR and c-Met by XL184 not only slows tumor growth but also decreases tumor invasiveness and liver metastasis and prolongs host survival. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 377.

Multidetector CT of Locally Invasive Advanced Gastric Cancer: Value of Oblique Coronal Reconstructed Images for the Assessment of Local Invasion

Purpose: To evaluate the diagnostic value of oblique coronal reconstructed CT images to determine the local invasion of advanced gastric cancer (AGC). Materials and Methods: Thirty-four consecutive patients, who were suspected to have locally invasive advanced gastric cancer (more than T3 stage) on a preoperative MDCT scan and underwent a diagnostic or curative laparotomy, were enrolled in this study. Two reviewers performed an independent blind review of three series of MDCT images in random order; axial (AXI), conventional coronal (CCI), and oblique coronal (OCI) (parallel to long axis of gastric body and pancreas) images. In assessing the local invasion, the reader’ confidence for the local invasion of AGC was graded using a five point scale (1 = definitely negative, 5 = definitely positive: T4). With surgical findings and histopathological proofs as reference standards, the diagnostic performance of the three different plans of CT images was employed for the verification of local invasion of AGC on a preoperative CT scan using the receiver operating characteristic (ROC) method. Agreements between the two reviewers were analyzed using weighted kappa statistics. Results: In 19 out of 34 patients, local invasion was confirmed surgically or histopathologically (13 pancreas invasion, 6 liver invasion, 4 major vascular invasion, 3 colon and mesocolon invasion, and 2 spleen invasion). The diagnostic performance of OCI was superior to AXI or CCI in the local invasion of AGC. The differences in the area under the curve of AXI (0.770 0.087, 0.700 0.094), CCI (0.884 0.058, 0.958 0.038), and OCI (0.954 0.050, 0.956 0.049), were statistically significant for both reviewers. Inter-observer agreement was excellent for OCI (= .973), which was greater than CCI (= .839), and AXI (= .763). Conclusion: On a CT scan, OCI might be a useful imaging technique in evaluating locally invasive advanced gastric cancer.

The relationship of serum CEA and CA 19-9 levels to liver metastasis and pancreatic invasion in esophageal cancer

Aim: Previous studies have examined levels of CEA and CA 19-9 in esophageal cancer patients, but have not determined a significant relationship between CEA and CA 19-9 levels and liver metastasis and pancreatic invasion in patients with esophageal cancer. In this study, we compared the serum levels of CEA and CA 19-9 in patients with esophageal cancer with and without liver and pancreatic metastasis. Materials and methods: The serum levels of CEA and CA 19-9 were measured in clinic patients between January 2007 and January 2008, including 10 patients with liver metastasis (4) and pancreas invasion (6), and 40 patients with esophageal cancer without distant organ metastasis. Results: A significant relationship was found between CEA levels in patients with liver metastasis and pancreatic invasion (P = 0.008 and P = 0.001, respectively). CA 19-9 levels were significantly higher in patients with pancreatic invasion compared to patients without pancreatic invasion (P = 0.001). There was also a significant difference in CA 19-9 levels between the group with liver metastasis and the group with pancreatic invasion (P = 0.028). Conclusion: It is important to measure serum CEA and CA 19-9 levels in all subjects with esophageal cancers in order to detect possible liver metastasis and pancreatic invasion.

Gastric Adenocarcinoma: Is Computed Tomography (CT) Useful in Preoperative Staging?

Although multiple studies testing the accuracy of CT in the preoperative staging of gastric adenocarcinoma have been carried out, their results are controversial. Whilst some authors claim that CT is an accurate method for preoperatively staging gastric cancer, others have advocated the contrary. Because of this discrepancy we have retrospectively reviewed preoperative CT findings compared with histopathological results in patients with gastric adenocarcinoma. Seventy-two patients diagnosed with gastric cancer who underwent potentially curative surgery and preoperative staging CT of quality were included in the study. The size, gastric wall thickening, presence of lymphadenopathy, adjacent organ invasion and location of the gastric mass was recorded. Early tumors (T1 and T2) and more advanced tumors (T3 and T4) were grouped together. CT staging was correlated with the final histopathological stage (TNM). The global results were expressed as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Seventy-two cases were included with fifty-five being male and a median age of 67 years (range 33-91). CT correctly identified the location of the tumor in 56 (53% antropyloric, 18% subcardial). Median time from CT scan to surgery was fourteen days (range 2-49). In T detection: T1/T2 and T3/T4 with sensitivity of 70% and 61%. Lymph node involvement: Sensitivity 49%. Overstaged in 47% Understaged in 75%. Specificity of 53%. Nine patients with colon-mesocolon (5 patients) and pancreas (4 patients) invasion. Sensitivity 44% and specificity 96%. Spiral CT is not an accurate method in predicting preoperative stages in gastric cancer.

Alveolar hydatid disease of the liver: Brief review and spectrum of adjacent organ invasion

The purpose of this study is to show the spectrum of adjacent organ invasion and to make a brief review of hepatic alveolar hydatid disease (AHD), using CT and MR imaging. We retrospectively reviewed CT and MR images of three patients with various adjacent organ invasions surgically and histologically proven to be AHD. Local invasion to right kidney and adrenal, right hemidiaphragm and lung were detected in one patient, right adrenal in another patient and gall bladder, duodenum, gastric wall and pancreas invasion in the other. AHD may rarely extend to the gall bladder, stomach, duodenum, pancreas, right adrenal and kidney, diaphragm, pleura and lung. The extension of the disease outside the liver is usually encountered in patients with large, peripherally located masses in the advanced stage of the disease.

Total Gastrectomy with Distal Pancreatico-splenectomy for Treating Locally Advanced Gastric Cancer

Purpose: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. Results: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 0.8%. Conclusion: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.

Results of Combined Gastrectomy and Pancreatic Resection in Patients with Advanced Primary Gastric Carcinoma

Background/Aims: Although the incidence of primary gastric carcinoma is decreasing, the majority of patients in Western countries are still diagnosed with advanced tumor stages. In many cases surgical therapy can be performed only by multivisceral resections including the pancreas. Methods: Between April 1986 and April 1997, thirty-three patients with primary gastric carcinoma underwent gastric resection and segmental/total pancreatectomy at our institution (21 males, 12 females; median age 57 years). The operative and pathologic findings and clinical course in these patients were analyzed retrospectively. Results: In all patients total gastrectomy with D2 lymphadenectomy was performed. In 26 patients (79%) the pancreatic tail was also resected. Other resections included the pancreatic head in 5 patients (15%) and the whole pancreas in 2 cases (6%). Radical (R0) resections were possible in 73% of all cases (n = 24). 22 patients (67%) had stage-IV disease due to liver/peritoneal metastases (n = 11) or to extensive lymph node metastases (N3, n = 11). Histology showed a predominance of the diffuse type according to Laurén (n = 16, 49%). Intraoperatively suspected tumor infiltration of the pancreas was confirmed by histology only in 39% (n = 13) of the examined resection specimens. Postoperative morbidity was 36% (n = 12) and mortality was 9% (n = 3). Five patients developed pancreatitis or peripancreatic abscess, 2 with a lethal outcome. Overall the median survival was 13 months. Following R0 resection median survival was 17 months. If the pancreas was microscopically not infiltrated, median survival was 23 months. Conclusion: Pancreatic invasion in patients with gastric carcinoma is often associated with positive lymph nodes and liver metastases or peritoneal carcinomatosis. Intraoperatively, true pancreas invasion is difficult to differentiate from inflammatory reactions. Postoperative morbidity and mortality are increased by pancreatic resection, mainly due to pancreatitis or peripancreatic abscess. Curative (R0) resection improves prognosis and even long-term survival can be achieved in selected individual cases. Palliative resections can be performed for local complications like bleeding or obstruction refractory to other therapies.

Prognosis and Surgical Treatment of Gastric Cancer Invading the Pancreas

The clinicopathologic characteristics of gastric cancer invading the pancreas have not been determined. Gastrectomy was performed in 282 patients with gastric cancer invading adjacent organs at the Department of Surgery II, Kyushu University Hospital, between 1970 and 1987, and patient data were retrospectively analyzed using univariate and multivariate analyses. Of these patients, 150 (53.2%) had tumors invading the pancreas and 132 had tumors invading adjacent organs other than the pancreas. In both groups, the undifferentiated tissue type with infiltrative growth, lymphatic involvement and lymph node metastasis was common. In cases of pancreas invasion, the extent of lymph node metastasis was more severe, vascular involvement was more frequent and the rate of concomitant liver metastasis was higher. The survival time of the patients with pancreas invasion was shorter compared to patients with cancer invading other organs, and pancreas involvement was one of the independent factors predicting a poor prognosis. With respect to surgical treatment of gastric cancer invading the pancreas, the prognosis was better for cases treated with curative surgery and pancreas resection. Of 39 patients treated with partial resection of the pancreas, the tumor had invaded only the capsule of the pancreas in 18 and the pancreas in the other 21. Pancreas-invasive gastric cancer cells are likely to advance via lymphatic and vascular routes and survival time is shorter, but curative resection can improve the survival rate, and perioperative treatment should be appropriately designed.

A CLINICAL STUDY OF ADVANCED PRIMARY DUODENAL CARCINOMA

Primary duodenal cancer is a rare disease that accounts for 0.8-2% of all gastrointestinal malignancies. Surgical resection is only the curative treatment, but optimal treatment opinion has not been established. We have experienced seven patients with primary advanced duodenal carcinoma so far, and successfully performed radical pancreatoduodenectomy for them. All tumors were at the second portion of the duodenum, and large over 50mm in maximum diameter. Tumors were resected safely in all patients, no local recurrences occurred after the operation. Pancreas invasion was seen in six patients, and lymph node metastasis was detected in three patients, however, the 5-year survival rate (66.7%) was excellent compared to prognoses of other periampullary tumors. Consequently, we should make an attempt to perform surgical treatment for primary duodenal cancer, if pancreas invasion or lymph node metastasis is suspected in preoperative examination.

Predictability of pancreas invasion from gastric cancer by CT

Predictability of pancreas invasion from gastric cancer by CT