Pancreaticoduodenectomy For Pancreatic Cancer Research Articles

Life-threatening upper gastrointestinal tract bleeding caused by ruptured extrahepatic pseudoaneurysm after pancreatoduodenectomy

Surgery offers the only chance of cure in patients with pancreatic cancer. Five-year survival of these patients has been relatively disappointing. This has led many surgeons to extend pancreatic resection to remove all neural and lymphoid tissue. 1 Tsuchyia R Tsunoda T Ishida T Saitoh Y Resection for cancer of the pancreas: the Japanese experience. Baillières Clin Gastroenterol. 1990; 4: 931-939 Abstract Full Text PDF PubMed Scopus (35) Google Scholar , 2 Cameron JL Crist DW Sitzmann JV Factors influencing survival after pancreatico-duodenectomy for pancreatic cancer. Am J Surg. 1991; 161: 120-124 Abstract Full Text PDF PubMed Scopus (552) Google Scholar Extensive surgical dissection includes skeletonization of hepatic arteries. We believe a rare complication of this is the formation of pseudoaneurysms, and these commonly present with massive upper gastrointestinal tract bleeding caused by rupture into the adjacent hepaticojejunostomy.

Life-threatening upper gastrointestinal tract bleeding caused by ruptured extrahepatic pseudoaneurysm after pancreatoduodenectomy

Surgery offers the only chance of cure in patients with pancreatic cancer. Five-year survival of these patients has been relatively disappointing. This has led many surgeons to extend pancreatic resection to remove all neural and lymphoid tissue. 1 Tsuchyia R Tsunoda T Ishida T Saitoh Y Resection for cancer of the pancreas: the Japanese experience. Baillières Clin Gastroenterol. 1990; 4: 931-939 Abstract Full Text PDF PubMed Scopus (35) Google Scholar , 2 Cameron JL Crist DW Sitzmann JV Factors influencing survival after pancreatico-duodenectomy for pancreatic cancer. Am J Surg. 1991; 161: 120-124 Abstract Full Text PDF PubMed Scopus (550) Google Scholar Extensive surgical dissection includes skeletonization of hepatic arteries. We believe a rare complication of this is the formation of pseudoaneurysms, and these commonly present with massive upper gastrointestinal tract bleeding caused by rupture into the adjacent hepaticojejunostomy.

Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer

Eighty-nine patients with carcinoma of the head of the pancreas underwent pancreaticoduodenectomies. The actuarial 5-year survival for all 89 patients was 19%, with a median survival of 11.9 months. The 81 hospital survivors were analyzed in an effort to determine factors influencing long-term survival. Negative lymph nodes and the absence of blood vessel invasion both favored long-term survival. The strongest predictive factor was negative lymph node status with a median survival of 55.8 months, compared with 11 months with lymph nodes involved with tumor (p less than 0.05). Blood transfusions were also predictive, with patients receiving two or fewer units having a median survival of 24.7 months, compared with 10.2 months for those receiving three or more units (p less than 0.05). The most important determinant of long-term survival after pancreaticoduodenectomy for pancreatic cancer is biology of the tumor (lymph node status, blood vessel invasion). However, performance of the resection (units of blood transfused) also appears to be an important factor influencing survival.

Carcinoma of the Pancreas

Pancreaticoduodenectomy (PD) with the possible addition of neoadjuvant or adjuvant therapy is the standard of care in the United States for adenocarcinoma originating in the pancreatic head, neck, and uncinate process. We reviewed 1423 patients who underwent a PD for a malignancy originating in the pancreas at our institution between 1970 and 2006. We examined 1175 PDs for ductal adenocarcinomas in greater detail. Eighteen different histological types of pancreatic cancer were identified; the most common diagnoses included ductal adenocarcinoma, neuroendocrine carcinoma, and IPMN with invasive cancer. Patients with ductal adenocarcinoma were analyzed in detail. The median age was 66 years, with patients in the present decade significantly older (68 years), on average, than patients in the three prior decades (e.g., 60 years in 1970, P = 0.02). The median tumor diameter was 3 cm; 42% of the resections had positive margins and 78% had positive lymph nodes. The perioperative morbidity was 38%. The median postoperative stay declined over time, from 16 days in the 1980s to 8 days in the 2000s (P < 0.001). The perioperative mortality declined from 30% in the 1970s to 1% in the 2000s (P < 0.001). The median survival for all patients with ductal adenocarcinoma was 18 months (1-year survival = 65 %, 2-year survival = 37%, 5-year survival = 18%). In a Cox proportional hazards model, pathological factors having a significant impact on survival included tumor diameter, resection margin status, lymph node status, and histologic grade. This is the largest single-institution experience with PD for pancreatic cancer. Patients who have cancers with favorable pathological features have a statistically significant improved long-term survival.