Surgical technique, curability and postoperative quality of life in an extended pancreatectomy for adenocarcinoma of the pancreas.

BACKGROUND/AIMS: In the treatment of adenocarcinoma of the pancreas, we have succeeded in both decreasing the locoregional recurrence and improving the patient's survival by adding a wide range of lymphatic and connective tissue clearance to the conventional pancreatectomy. The present paper shows the detailed techniques of this procedure and the factors associated with long-term survival to provide a better understanding of the indications and limitations.
MATERIALS AND METHODS: The postoperative survival rate in association with the background factors of the tumor and the quality of life is analyzed in 62 patients who received an extended pancreatectomy of ductal carcinoma of the pancreas. In this procedure, a wide range of lymphatic and connective tissue clearance was cleared in addition to the pancreatectomy, skeletonizing the major vessels.
RESULTS: The long-term survivors had the following background factors: tumor diameter 4 cm or less; no nodal involvement or involvement limited to the immediate region of the tumor (n1-group); PV/SMV-invasion was absent or slight (2 cm or less in length and hemilateral). Long-term survival was rarely expected for any patients who had more advanced factors. Since removing the nerve plexi and connective tissues skeletonize major vessels, most patients did not recover their health easily within one post-operative year.
CONCLUSION: While our extended pancreatectomy is the most promising procedure at present, providing the candidate is appropriate, its indication should be carefully selected because of the patient's quality of life and cost-performance.