Practical Usefulness of Lymphatic and Connective Tissue Clearance for the Carcinoma of the Pancreas Head

Abstract

We performed a retrospective review of 59 pancreatic resections for ductal carcinoma of the pancreas head performed between 1971 and 1983. In addition to pancreaticoduodenectomy, 37 consecutive patients (from 1971 to 1981) received lymphatic dissection adjacent to the pancreatic head (Group R1), whereas another 22 patients (from 1981 to 1983) received a wider range of lymphatic and soft tissue dissection, including the para-aortic region (Group R2). These groups did not differ with regard to operative mortality rate or background factors in the patients who tolerated operation. The 3-year cumulative survival rate was 13% in the R1 group vs. 38% in the R2 group (p less than 0.05). Almost all of the deaths from cancer recurrence occurred within 3 years after operation; the cumulative rate of death from local recurrence decreased from 67 to 16% (p less than 0.05) at 3 years. Among the patients with nodal involvement, there was no 3-year survivor in the R1 group, but four (27%) in the R2 group (p less than 0.05) survived. Among the patients whose tumor size exceeded 4 cm with retroperitoneal invasion, there was no 3-year survivor in either group and most patients died of distant metastasis. Extended clearance of regional lymph nodes and soft tissue appears to benefit patients with ductal carcinoma of the pancreatic head whose tumor size is less than 4 cm without severe invasion to the retroperitoneal space.

Carcinomas of the ventral and dorsal pancreas exhibit different patterns of lymphatic spread

“…However, dismal complications affecting the quality of life, particularly disturbances in digestive absorption such as diarrhea, are a significant morbidity associated with this type of surgery (3,5). Furthermore, many of those patients who die after a potentially curative resection die from local recurrences (6). Four prospective randomized trials have compared a standard pancreatoduodenectomy versus one with an extended lymphadenectomy for patients with potentially curative pancreatic head adenocarcinoma (5,(7)(8)(9).…”

Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry

“…In many studies involving extensive surgery, the prognosis did not seem to be substantially influenced or improved. [1][2][3][4][5][6] The reported values on long time survivors of PDAC have been questioned and it has been claimed that they are markedly lower than reported. While five year survival rates of 30-55% in PDAC patients treated with a curative intent have been published, [7][8][9][10][11] reports of actual five year survival have usually been more modest, (approximately 10-20% for patients undergoing curative resection).…”

Risk factors influencing recurrence following resection of pancreatic head cancer

“…Lymph vessel invasion might imply lymphatic metastasis before cancer cells flowed into lymph nodes. If nodal involvement was found in n1 region, microinvasion had already occurred in the n2 region [22] . If n2 and n3 groups were invaded , the chance of distant recurrence was much increased.…”