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Faivre  JForman  DEsteve  JObradovic  MSant  MEUROCARE Working Group, Survival of patients with primary liver cancer, pancreatic cancer and biliary tract cancer in Europe.  Eur J Cancer. 1998;342184- 2190PubMedGoogle ScholarCrossref
Trede  MSchwall  GSaeger  HD Survival after pancreatoduodenectomy: 118 consecutive resections without an operative mortality.  Ann Surg. 1990;211447- 458PubMedGoogle ScholarCrossref
Cameron  JLPitt  HAYeo  CJLillemoe  KDKaufman  HSColeman  J One hundred and forty-five consecutive pancreaticoduodenectomies without mortality.  Ann Surg. 1993;217430- 435PubMedGoogle ScholarCrossref
Ishikawa  OOhhigashi  HSasaki  Y  et al.  Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head.  Ann Surg. 1988;208215- 220PubMedGoogle ScholarCrossref
Manabe  TOhshio  GBaba  N  et al.  Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas.  Cancer. 1989;641132- 1137PubMedGoogle ScholarCrossref
Nagakawa  TKonishi  IUeno  K  et al.  Surgical treatment of pancreatic cancer: the Japanese experience.  Int J Pancreatol. 1991;9135- 143PubMedGoogle Scholar
Pedrazzoli  SDiCarlo  VDionigi  R  et al. Lymphadenectomy Study Group, Standard versus extended lymphadenectomy associated with pancreato-duodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study.  Ann Surg. 1998;228508- 517PubMedGoogle ScholarCrossref
Henne-Bruns  DVogel  ILuttges  JKloppel  GKremer  B Surgery for ductal adenocarcinoma of the pancreatic head.  World J Surg. 2000;24595- 601PubMedGoogle ScholarCrossref
Yeo  CJCameron  JLLillemoe  KD  et al.  Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2.  Ann Surg. 2002;236355- 368PubMedGoogle ScholarCrossref
Fuhrman  GMLeach  SDStaley  CA  et al. Pancreatic Tumor Study Group, Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence.  Ann Surg. 1996;223154- 162PubMedGoogle ScholarCrossref
Harrison  LEKlimstra  DSBrennan  MF Isolated portal vein involvement in pancreatic adenocarcinoma.  Ann Surg. 1996;224342- 347PubMedGoogle ScholarCrossref
Takahashi  SOgata  YTsuzuki  T Combined resection of the pancreas and portal vein for pancreatic cancer.  Br J Surg. 1994;811190- 1193PubMedGoogle ScholarCrossref
Allema  JHReinders  MEvan Gulik  TM  et al.  Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head.  Br J Surg. 1994;811642- 1646PubMedGoogle ScholarCrossref
Hamilton  SRAaltonen  LA Pathology and Genetics of Tumours of the Digestive System.  Washington, DC IARC Press2000;
International Union Against Cancer (UICC), TNM: Classification of Malignant Tumours. 6th ed. New York, NY Wiley-Liss2002;
Japan Pancreas Society, Classification of Pancreatic Carcinoma.  Tokyo, Japan Kanehara & Co Ltd1996;
Fortner  JG Regional resection of cancer of the pancreas: a new surgical approach.  Surgery. 1973;73307- 320PubMedGoogle Scholar
Hirata  KSato  TMukaiya  M  et al.  Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas.  Arch Surg. 1997;132771- 776PubMedGoogle ScholarCrossref
Gall  FPKessler  HHermanek  P Surgical treatment of ductal pancreatic carcinoma.  Eur J Surg Oncol. 1991;17173- 181PubMedGoogle Scholar
Massucco  PCalgaro  MBertolino  FBima  CGalatola  GCapussotti  L Outcome of surgical treatment for chronic calcifying pancreatitis.  Pancreas. 2001;22378- 382PubMedGoogle ScholarCrossref
van Heerden  JAReMine  WHWeiland  LHMcIlrath  DCIlstrup  DM Total pancreatectomy for ductal adenocarcinoma of the pancreas: Mayo Clinic experience.  Am J Surg. 1981;142308- 311PubMedGoogle ScholarCrossref
Andren-Sandberg  AIhse  I Factors influencing survival after total pancreatectomy in patients with pancreatic cancer.  Ann Surg. 1983;198605- 610PubMedGoogle ScholarCrossref
Allema  JHReinders  MEvan Gulik  TM  et al.  Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region.  Cancer. 1995;752069- 2076PubMedGoogle ScholarCrossref
Yeo  CJAbrams  RAGrochow  LB  et al.  Pancreaticoduodenectomy for pancreatic adenocarcinoma.  Ann Surg. 1997;225621- 633PubMedGoogle ScholarCrossref
Millikan  KWDeziel  DJSilverstein  JC  et al.  Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas.  Am Surg. 1999;65618- 623PubMedGoogle Scholar
Park  SJKim  SWJang  JYLee  KUPark  YH Intraoperative transfusion: is it a real prognostic factor of periampullary cancer following pancreatoduodenectomy?  World J Surg. 2002;26487- 492PubMedGoogle ScholarCrossref
Ishikawa  OOhigashi  HImaoka  S  et al.  Is the long-term survival rate improved by preoperative irradiation prior to Whipple's procedure for adenocarcinoma of the pancreatic head?  Arch Surg. 1994;1291075- 1080PubMedGoogle ScholarCrossref
Kokubo  MNishimura  YShibamoto  Y  et al.  Analysis of the clinical benefit of intraoperative radiotherapy in patients undergoing macroscopically curative resection for pancreatic cancer.  Int J Radiat Oncol Biol Phys. 2000;481081- 1087PubMedGoogle ScholarCrossref
Cameron  JLCrist  DWSitzmann  JV  et al.  Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer.  Am J Surg. 1991;161120- 124PubMedGoogle ScholarCrossref
Geer  RJBrennan  MF Prognostic indicators for survival after resection of pancreatic adenocarcinoma.  Am J Surg. 1993;16568- 72PubMedGoogle ScholarCrossref
Roder  JDStein  HJSiewert  JR Carcinoma of the periampullary region: who benefits from portal vein resection?  Am J Surg. 1996;171170- 174PubMedGoogle ScholarCrossref
Kremer  BVogel  ILuttges  JKloppel  GHenne-Bruns  D Surgical possibilities for pancreatic cancer: extended resection.  Ann Oncol. 1999;10 ((suppl 4)) 252- 256PubMedGoogle ScholarCrossref
Nakao  AHarada  ANonami  TKaneko  TInoue  STakagi  H Clinical significance of portal invasion by pancreatic head carcinoma.  Surgery. 1995;11750- 55PubMedGoogle ScholarCrossref
Original Article
December 1, 2003

Extended Lymphadenectomy and Vein Resection for Pancreatic Head Cancer: Outcomes and Implications for Therapy

Author Affiliations

From the Unit of Surgical Oncology, Institute for Research and Cure of Cancer, Candiolo, Italy, and Department of Surgery, Ospedale Mauriziano Umberto I, Torino, Italy.

Arch Surg. 2003;138(12):1316-1322. doi:10.1001/archsurg.138.12.1316

Hypothesis  An aggressive strategy that includes extended lymphadenectomy and vein resection may improve the results of surgical treatment of pancreatic head cancer.

Design  Nonrandomized control trial.

Setting  Tertiary care referral center.

Patients  The study included 149 consecutive patients undergoing macroscopically curative resection for periampullary adenocarcinoma from January 1, 1988, to December 31, 1998.

Interventions  A standard resection was performed in 122 cases; an extended lymphadenectomy in 37. Twenty-four patients underwent venous resection.

Main Outcome Measures  Data on surgical mortality, morbidity, and postoperative outcome, pathological findings, and long-term survival were analyzed.

Results  In-hospital and 60-day operative mortality was 5.4%. Morbidity was 37.5%. Mortality, morbidity, and postoperative stay were nonsignificantly modified by extended lymphadenectomy or venous resection. Extended resection permitted the identification of a significantly higher percentage of nodal metastases beyond the peripancreatic node groups. In patients undergoing vein resection, a significantly higher rate of positive retroperitoneal margin was found. In the 100 patients with ductal adenocarcinoma, the median overall survival and the 5-year actuarial survival rate were 15 months and 8.4%, respectively. A trend toward a better survival was observed in the first 2 years after operation in the extended resection group compared with the standard resection group. Nodal status was the most powerful predictor of overall survival by multivariate analysis.

Conclusions  Extended lymphadenectomy and vein resection did not adversely affect postoperative mortality and morbidity. Patients who required a vein resection were less likely to receive a microscopically curative pancreatectomy. Extended resection permitted better pathological staging and was associated with an early advantage in survival, but long-term survival was possible only in patients with favorable prognostic factors.