The Surgical Treatment of Pancreatic Cancer

Nagakawa, Takukazu; Yonemura, Yutaka; Koyama, Koji; Kurachi, Madoka; Sasaki, Makoto; Miwa, Koichi; Kinami, Yoshio; Miyazaki, Itsuo

doi:10.5833/jjgs.12.611

Cited by 11 publications

(8 citation statements)

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“…The 30-day operative mortality rate was 5.3% (3 of 56); subtotal resection, 3.8% (1 of 26); total resection, 6.6% (2 of 30). The patient with the fatal subtotal resection died of gram-negative sepsis with cardiac arrest on postoperative day 5.…”

Section: Methodsmentioning

confidence: 99%

Tumor Size Is the Primary Prognosticator for Pancreatic Cancer After Regional Pancreatectomy

Fortner¹,

Klimstra

Senie³

et al. 1996

Annals of Surgery

215

116

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ObjectiveThe purpose of this study was to evaluate the regional pancreatectomy as surgical therapy for ductal adenocarcinoma of the pancreas and to evaluate potential prognostic factors. Summary Background DataRegional pancreatectomy was developed as a more adequate surgical procedure for pancreatic cancer in an attempt to improve the cure rate for this highly lethal disease. Few studies have evaluated large numbers of patients treated with this technique, and in recent years the emphasis has been on more limited surgery for pancreatic cancer. MethodsFifty-six patients with ductal adenocarcinoma of the pancreatic head were treated by regional subtotal or total pancreatectomy. Clinica and pathologic parameters were reviewed and potential prognostic factors were compared statistically. The three patients who died wfithin 30 days of the operation were excluded from the survival analysis. ResultsPrimary tumor size was the strongest deterninant of prognosis. The mean tumor size was 3.9 cm (range, 1-7 cm). Eighty-five percent of patients had peripancreatic soft tissue invasion microscopically, and 58% had regional lymph node metast. Kaplan-Meier survival curves indicated a 33% 5-year survival for patients with tumor 2.5 cm or less in diameter (n = 12) and 12% for patients with larger tumors (n = 39). No patient with a tumor ldrger than 5 cm survived more than 5 years. Mean tumor size was not significantly associated with lymph node metastase, but 5 of 12 patients (42%) with primary tumor <2.5 cn had lymph node metastases. Twenty-four percent of patients with negative lymph nodes and 14% with positive lymph nodes survived 5 years. The difference was not sistically significnat (p = 0.3), but this is likely related to sample size. The 30.day operative mortality was 5.3%. The most common complications were infecfion, gastrointestnal bleeding, and gastric stasis. ConclusionsAfter regional pancreatectomy, tumor size is the strongest predictor of prognosis. A multiinstbiuioal mndomized prospectve Wial of regional pancreatectomy versus pancreaicoduodenectomy is warranted in previously untreated, noninfected cases. 147

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Section: Methodsmentioning

confidence: 99%

Tumor Size Is the Primary Prognosticator for Pancreatic Cancer After Regional Pancreatectomy

Fortner¹,

Klimstra

Senie³

et al. 1996

Annals of Surgery

215

116

View full text Add to dashboard Cite

show abstract

“…So berichten einzelne Studien u È ber eine Verbesserung der Ûberlebensrate auf 34±38% im Vergleich zu Pankreasresektionen ohne erweiterte Lymphknotendissektion [11,12]. Ebenso zeigen nichtvergleichende Studien hohe Langzeitu È berlebensraten mit Werten zwischen 24 und 33% [10,26,29]. Demgegenu È ber berichten anderen Studien neueren Datums mit Fallzahlen von 90 und 1 001 Fa Èllen u È ber Langzeitu È berlebensraten zwischen 5 und 10% [17,30], die sich damit nicht von den Resultaten der konservativen Resektionsverfahren unterscheiden [4].…”

Section: Diskussionunclassified

Stellenwert der erweiterten Lymphknotendissektion beim Pankreaskarzinom

Wagner¹,

Baer²,

Büchler³

1998

Visc Med

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“…Among the several parts of the extrapancreatic neural plexus which demonstrate local tumor recurrence, pancreatic head plexus and splenic plexus are the most common sites of tumor recurrence (Liu&Lu, 2002). Based on the frequency of NI towards retropancreatic neural plexus, several surgeons advocated routine extended resections (including celiac plexus) or at least more aggressive surgery in the surgical treatment of PCa (Hiraoka et al, 1986;Nagakawa et al, 1991;Nagakawa et al, 1996;Imamura et al, 1999). However, subsequent clinical studies confirmed that, while extended resection -even in combination with radiotherapy-can contribute to local tumor control, there is no survival benefit for patients due to the early spread pattern of PCa (Bachmann et al, 2006;Takamori et al, 2008;Yokoyama&Nagino, 2011).…”

Section: Why Is Neural Invasion So Deciding In the Course Of Pca?mentioning

confidence: 99%

“…In the face of such a high prevalence, NI is at the same time one of the foremost reasons for local tumor recurrence after curative tumor resection Nagakawa et al, 1991;Kayahara et al, 1995;Kayahara et al, 1996;Nagakawa et al, 1996;Ozaki et al, 1999). In a study by Kayahara et al, the investigators analyzed the mode of recurrence in 30 patients who had originally undergone macroscopically curative resection (Kayahara et al, 1993;Liu&Lu, 2002).…”

Section: Why Is Neural Invasion So Deciding In the Course Of Pca?mentioning

confidence: 99%