Seventy-four patients were treated with a radical or a nonradical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Their survival rates and the selection of the operative procedure were evaluated. In 32 patients, a radical pancreatectomy was attempted where there was sufficient clearance of regional or juxta-regional lymph nodes beyond the group of suspected metastatic nodes, as well as a resection of a greater margin of soft tissue around the pancreas. These patients' cumulative 5-year survival rate was 33.4%. In 14 Stage I or Stage 11 patients, the cumulative 5-year survival rate was 46.4%. In 18 Stage 111 or Stage IV patients, the cumulative 5-year survival rate was 20.7%. For 42 patients treated with a nonradical pancreatectomy with the dissection of lymph nodes adjacent to the pancreas or of regional lymph nodes but with insufficient clearance of the soft tissue around the pancreas, the cumulative 2-year and 3-year survival rates were 5.4% and 0%, respectively. In seven patients with Stage I1 carcinoma, the survival rate was 16.7% after 2 years and 0% after three years. In 35 Stage I11 or Stage IV patients, the survival rate was 3.2% after 2 years and 0% after 3 years. Thus, the survival rates were significantly higher in patients treated with radical operation than in patients who had nonradical operation. These results indicate that a radical pancreatectomy with sufficient lymph node clearance with the surrounding connective tissue around the pancreas is indispensable to cure patients with ductal cell carcinoma of the pancreas. Cancer 64:1132-1137. 1989. ESPITE the development of new diagnostic aids such D as ultrasonography, computerized tomography, en-doscopic retrograde pancreatocholangiography, and an-giography, the prognosis for patients with pancreatic car-cinoma, particularly pancreatic ductal cell carcinoma, is poor because of the tumor's low resectability and a limited postoperative survival time when compared with other gastrointestinal malignant neoplasms. In most cases, tumors extend to the outer margin of the pancreas and infiltrate the pancreatic capsule and adjacent vessels. ',* Even if these lesions appear to be resected in the course of pan-createctomy, they are often overlooked since invisible microscopic lesions may be left behind. Therefore, the primary lesion should be removed with as much surrounding, apparently noncancerous tissues as is feasible, including an en bloc removal of the regional From the First

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The effects of cholecystokinin (CCK) and a CCK antagonist, loxiglumide (CR-1505), on four freshly separated and six xenografted human pancreatic cancers, were investigated. The level of DNA synthesis in only one of five tested pancreatic cancers was enhanced by CCK at concentrations of 0.01-10 nM, while in the other four cancers DNA synthesis was not affected. The levels of DNA, RNA, and protein synthesis (by 3H-thymidine, 3H-uridine, and 3H-leucine incorporation tests, respectively) in all the tested cancers were dose-dependently inhibited by loxiglumide at concentrations of 20-2000 microM, and the IC50 of loxiglumide for DNA synthesis in pancreatic cancers was 156 +/- 80 microM (means +/- SD). The in vivo effect of loxiglumide was assessed using a xenografted line (PC-HN) transplanted in nude mice. The in vivo 50% lethal dose of loxiglumide for nude mice was about 500 mg/kg. Death was caused by respiratory failure due to severe congestion of the lung after the administration of a large dose of loxiglumide. The growth of a PC-HN transplanted in the nude mice was significantly inhibited by subcutaneous loxiglumide at 250 mg/kg, twice a day for 28 days, which did not cause death. It is suggested that loxiglumide inhibits the in vivo and in vitro growth of human pancreatic cancer, perhaps independently of its action as a CCK antagonist, and this study also suggests that loxiglumide may be a new type of therapeutic agent to be used for the treatment of human pancreatic cancer.

The common duct was ligated in 25 dogs, 5 of which served as controls. Serum bilirubin, GOT, GPT, and alkaline phosphatase were measured pre-and postoperatively. Eight days later, in 10 dogs, a longitudinal incision was made across the stenosed segment of the common bile duct, which was then widened with a Teflon | patch. In 10 other dogs, the stenosis was resected and the defect was bridged with a Teflon | prosthesis. A few days later, laboratory parameters returned to normal. Histological examination after 4 weeks showed that the Teflon | patch and Teflon | prosthesis were lined with bile duct epithelium. X-ray studies 6, 12 and 24 months after repair showed no evidence of stenosis.We conclude that it is possible to use a Teflon | graft in reconstructive common bile duct surgery.