Total pancreatectomy for carcinoma of the pancreas

Lawrence, Arthur Gene; Ghosh, Bimal C.

doi:10.1016/0002-9610(77)90091-5

The American Journal of Surgery

1977

DOI: 10.1016/0002-9610(77)90091-5

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Total pancreatectomy for carcinoma of the pancreas

Arthur Gene Lawrence

Bimal C. Ghosh

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Cited by 5 publications

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“…Under Crile's influence [2], palliative bypass was long preferred. Brooks and Culebras [3], Fortner et al [4], Ihse et al [5], Lawrence and Ghosh [6], Moossa et al [7], Pliam and Remine [8], and Matsui et al [9] have endorsed excision as the treatment of choice. The results of total pancreatectomy, however, have been disappointing [10].…”

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Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer

et al. 1993

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Between March 1, 1968 and March 1, 1986, 323 patients underwent surgery for cancer of the pancreas or the periampullary region. Extirpative procedures were performed in 91 patients, of whom 51 had ductal carcinoma of the pancreas. Forty-seven patients had total pancreatectomy, 9 associated with resection of the portal vein and 1 with total gastrectomy. Operative mortality was 15% but fell to zero for the 19 total pancreatectomies performed after 1981. With the introduction of total pancreatectomy, the resectability rate increased from 15% to 32%. Overall mean survival was 14.4 months. Actuarial survival was 42.4% at 1 year, 25.6% at 2 years, 11.9% at 3 years, and 8% at 5 years. Six patients are alive 7, 11, 14, 30, 30, and 73 months, respectively, after operation. Survival was calculated according to the classifications of Hermreck, Tryka and Brooks, and the TNM system. Ductal carcinoma was multifocal in 32% of patients, and 25% had epithelial dysplasia of the pancreatic duct. When portal vein resection was necessary, mean survival was 6.1 months, compared with 18.25 months when it was not performed. We conclude that total pancreatectomy has increased our resectability rate, mainly in patients with tumor spread beyond the usual margins of division for Whipple's procedure. However, the procedure does not appear worthwhile when portal vein resection is necessary or when multicentric cancer or neoplastic emboli are observed in the operative specimen.

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confidence: 99%

Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer

et al. 1993

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Analysis of pancreatoduodenectomy

O’Brien

Mincey

1985

Journal of Surgical Oncology

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Between 1956 and 1982, there were 55 pancreatoduodenectomies performed at the Medical University of South Carolina by 19 different surgeons. There were 26 resections for adenocarcinoma of the head of the pancreas and 16 resections for carcinoma of the ampulla of vater, carcinoma of the extrahepatic biliary ducts, and carcinoma of the duodenum. There were seven resections for chronic pancreatitis. There were two resections for trauma and three resections in the (1960s) for carcinoma of the stomach. There was one resection for cystadenocarcinoma of the pancreas. In the patients with carcinoma of the pancreas, resection was only performed when there was no gross evidence of extension beyond the parenchyma of the pancreas. Analysis of the resected specimen revealed 44% of the pancreatic carcinomas subsequently had positive lymph nodes. None of these patients became long-term survivors. Failure of the pancreato-jejunostomy was the most serious complication, occurring in 7 of 55 resections. There were no fistulas where a mucosal to mucosal anastomosis was performed to join the pancreas with the jejunum. The five-year survival for all patients with carcinoma of the pancreas was 11.6%. The 3 five-year survivors were from resections performed between 1956 and 1970. During these years, the mortality rate for the procedure was 21%. From 1970 to 1982 there were no five-year survivors from carcinoma of the pancreas. However, the mortality rate was 10.6%. The history and current controversies over this surgical procedure are reviewed.

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Application of the immunoperoxidase method for rapid intraoperative pathological diagnosis of pancreatic cancer

Ichihara

Nakao

Sakamoto

et al. 1989

Journal of Surgical Oncology

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Intrapancreatic extension of pancreatic duct cell carcinoma in 19 resectable cases was evaluated by both hematoxylin and eosin (H&E) staining and quick immunostaining using antibodies against cancer-associated antigens--e.g., CA19-9, DUPAN 2, and CEA--on the intraoperative frozen-section biopsy during the course of laparotomy. By H&E staining, malignant lesions were identified in four of 19 cases (21%). By the immunostaining method, however, cancer cells were detected in 10 of 19 cases (52.6%). This immunostaining method was particularly useful in defining cancer cells surrounded by dense fibrous connective tissue, in which cancer cells are usually difficult to evaluate by H&E staining. Thus, the application of such immunostaining, together with H&E staining, on the cryostat sections of biopsy specimens may provide important information for the appropriate operative method. Retrospective study of permanent sections revealed that pathological diagnosis by quick immunostaining was more accurate than diagnosis by H&E staining.

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Total pancreatectomy for carcinoma of the pancreas

Cited by 5 publications

References 4 publications

Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer

Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer

Analysis of pancreatoduodenectomy

Application of the immunoperoxidase method for rapid intraoperative pathological diagnosis of pancreatic cancer

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