BACKGROUND/AIMS: En bloc resection of a tumor located in the uncinate process of the pancreas is a challenging problem. The aim of this study was to analyze outcomes of modified Miwa's augmented regional pancreatoduodenectomy for patients with pancreatic cancer in the uncinate process involving the root of the mesentery. METHODOLOGY: We analyzed by summarizing the 48 cases of ductal adenocarcinoma in the uncinate process of the pancreas during January 2004 to December 2010 with Miwa's augmented regional pancreatoduodenectomy in our hospital and examined the clinical effect and safety of this procedure. RESULTS: We performed extended pancreaticoduodenectomy combined with isolation of full-length superior mesentery artery (SMA) for 48 patients. Sixteen of the forty-eight patients were combined with PV/SMV resection and reconstruction. There was no operative death and 20 cases developed complications, including mild to severe diarrhea in 17 cases. During follow-up survey among all patients of 6 to 45 months (median 20 months), 9 died of liver metastasis, 10 died of local recurrence, and 5 died of non-tumor causes. The 1-, 2- and 3-year accumulated survival rates were 69.1%, 35.1% and 20.2%, respectively. CONCLUSIONS: Full-length SMA isolation and involved mesentery resection with extended pancreaticoduodenectomy is safe and effective.
BACKGROUND/AIMS: En bloc resection of a tumor located in the uncinate process of the pancreas is a challenging problem. The aim of this study was to analyze outcomes of modified Miwa's augmented regional pancreatoduodenectomy for patients with pancreatic cancer in the uncinate process involving the root of the mesentery. METHODOLOGY: We analyzed by summarizing the 48 cases of ductal adenocarcinoma in the uncinate process of the pancreas during January 2004 to December 2010 with Miwa's augmented regional pancreatoduodenectomy in our hospital and examined the clinical effect and safety of this procedure. RESULTS: We performed extended pancreaticoduodenectomy combined with isolation of full-length superior mesentery artery (SMA) for 48 patients. Sixteen of the forty-eight patients were combined with PV/SMV resection and reconstruction. There was no operative death and 20 cases developed complications, including mild to severe diarrhea in 17 cases. During follow-up survey among all patients of 6 to 45 months (median 20 months), 9 died of liver metastasis, 10 died of local recurrence, and 5 died of non-tumor causes. The 1-, 2- and 3-year accumulated survival rates were 69.1%, 35.1% and 20.2%, respectively. CONCLUSIONS: Full-length SMA isolation and involved mesentery resection with extended pancreaticoduodenectomy is safe and effective.