Aggressive resection for advanced pancreatic carcinoma

Abstract

An aggressive pancreatectomy was performed on a 53 year old Japanese man with advanced cancer of the pancreas. The tumor originated from the body of the pancreas and invaded the stomach, duodenum, left kidney, transverse colon and common hepatic artery. An unexpected cancer was also found in the head of the pancreas during the operation. Therefore, total pancreatectomy, total gastrectomy, left adrenonephrectomy, resection of the left transverse colon and dissection of the regional lymph nodes were performed. Resection of the common hepatic artery was also performed, followed by an end-to-end anastomosis between the common hepatic artery and celiac trunk. The postoperative course was uneventful and the patient was doing well until nine months after the operation when multiple metastatic lesions were noted in the liver. He died 391 days after the operation from hepatic failure.

Assessment of Risk Factors for Pancreatic Resection for Cancer

“…More recent series [10,18,[32][33][34] have shown that these operations can be performed with a moderate risk in patients over age 70 as well. In the present study an age over 70 years did not represent an absolute contraindication for surgery (nine resections performed) and involved only moderate morbidity (a single, albeit fatal, complication).…”

“…Elderly age has long been considered a contraindication for pancreatic resection based on series reported in the literature [23,31] that indicated markedly increased morbidity and mortality in patients over 65 to 70 years of age. More recent series [10,18,[32][33][34] have shown that these operations can be performed with a moderate risk in patients over age 70 as well. In the present study an age over 70 years did not represent an absolute contraindication for surgery (nine resections performed) and involved only moderate morbidity (a single, albeit fatal, complication).…”

“…Moreover, large series with a zero postoperative mortality rate have been reported [10,11]. Such results, which can most likely be ascribed to the improvement in surgical and anesthetic procedures and perioperative intensive therapy, have created a progressive increase in the indications for pancreatic resection [12][13][14][15][16][17][18]. Postoperative morbidity is still high, however, ranging at present between 38.5% and 65.8% [6, 7, 9, 10, 19 -21].…”