"How I do it".

Pancreatoduodenectomy is now the most fundamental operation for cancer of the pancreatic head. However, with the conventional operative procedure, the resection rate is low and long-term results are extremely poor. We introduced an extended radical Whipple operation in 1978 to improve surgical curability. Systemic dissection of extended lymph nodes and plexuses and en bloc resection of the portal vein was the basic concept. The resection rate for cancer of the pancreatic head has improved from 7–20 to 50%. The curative resection rate has also improved from 10 to 40–50%. The extended procedure did not increase the risk of the Whipple operation. When curative surgery was performed, good long-term survival was expected even in cases of extensive invasion to the portal vein. As a result, 11 patients who underwent curative surgery have survived for a long period of time. At present, however, the majority of patients are in an advanced stage at diagnosis and extended radical operation plays an important role in the curative therapy for this condition. OOOOOOOOOOOOOOOOOOOOOO Received: February 17, 1997 Accepted: March 20, 1997 Dr. T. Imaizumi Institute of Gastroenterology Tokyo Women’s Medical College Kawada-cho 8-1, Shinjuku-ku Tokyo 162 (Japan) ABC Fax + 41 61 306 12 34 E-Mail [email protected] www.karger.com © 1998 S. Karger AG, Basel 0253–4886/98/0154–0299$15.00/0 Accessible online at: http://BioMedNet.com/karger Introduction Despite advances in diagnostic methodology, early detection of cancer of the pancreas is still rare. Therefore, surgery is often performed in advanced cases of invasive ductal adenocarcinoma and the long-term prognosis is poor. The 5-year survival rate for pancreatic cancer is estimated to be 3.5–25% in Western Europe and North America [1–9]. The 1993 annual report of registered cases of pancreatic cancer in Japan [10] showed that the 5-year survival rate was 17.5% after curative surgery, much lower than that for other cancers of the gastrointestinal tract. In the early years, our department performed only ‘standard operation’ to remove the main tumor; therefore, the resection rate was low and surgical treatment was often non-curative. Reflecting on the poor results and inspired by Fortner’s [11] report on regional pancreatectomy, we introduced extended radical Whipple operation in 1978 [12]. Depending on the extent of cancer invasion, major vessels including the portal vein, lymph nodes and nerve plexuses were resected en bloc in order to improve the radicality. After trial and error, we now have eleven 5year survivors. This paper reports the operative procedure for invasive ductal adenocarcinoma of the pancreatic head and the postoperative results achieved in our department.