[Clinico-pathological study on the appropriate range of pancreatic resection to obtain operative curability of pancreatic head cancer].

We studied the mode of spread on the pancreatic head carcinoma histologically in association with the patient survival period and the mode of cancer recurrence. The histological materials were 41 surgically resected specimens and 12 autopsied specimens. The mode of cancer spread were classified into 5 factors: continuous spreading along the caudal pancreatic duct wall; dysplastic lesion; multicentric cancer lesion; lymphatic infiltration; lymph node metastasis and direct invasion toward the retroperitoneal space. As a result, total pancreatectomy is considered as rationale only when continuous ductal infiltration spreads into the duct in pancreatic tail, but the cut margin of the pancreas should be 2 cm distant, at least, by the macroscopical observation. Additionally, frozen section of the cut line, cytological examinations of the pancreatic juice and duct epithelium in remaining pancreas should be negative. It was remarkable that the patient's prognosis depended upon the lymph-node involvement and retroperitoneal invasion at the surgical resection. Therefore, it is most important to do prophylactic resection of a soft tissue behind the pancreas including lymph nodes in the retroperitoneal space.