Surgical possibilities for pancreatic cancer: extended resection.

DESIGN It was the aim of this study to investigate the influence of extended retroperitoneal tissue clearance on long-term survival in patients with ductal adenocarcinoma of the head of the pancreas. PATIENTS AND METHODS From 10/1988 to 3/1998 a prospective observation study was initiated in 108 patients with malignant growth in the head of the pancreas to compare patients with regional lymphadenectomy (RLA) versus extended retroperitoneal tissue clearance (ELA). In 36 patients other tumors than ductal adenocarcinomas were found, so that 72 patients with a partial pancreaticoduodenectomy and a histologically established diagnosis of ductal adenocarcinoma were included. Pancreaticoduodenectomy was combined with RLA in 26 cases and with ELA in 46 patients. RESULTS Comparing only R0-resected patients (n = 58) no significant difference in long-term survival rates between the RLA and the ELA group was found. Hospital mortality was 3.8% in the RLA group and 6.5% in the ELA group. Significant or nearly significant results were shown for the following parameters: STAGE OF THE DISEASE: Patients after partial pancreaticoduodenectomy of a stage I/II cancer of the head of the pancreas showed a 63% 5-year survival rate compared to 15% in patients in stage III or IV (p = 0.0087). GRADING: No patient with a poorly differentiated ductal adenocarcinoma of the head of the pancreas survived the first year in comparison to 55% of patients with well or moderately differentiated tumors (p = 0.0022). N-STAGE: 5-year survival of patients in NO stage was 46.9% and 15% for N1 stage patients (p = 0.081). PORTAL VEIN INFILTRATION: No patient with a R0-resection and histologically proven tumor infiltration of the portal vein survived the first year whereas 63% of patients did so after curative resection without portal vein involvement (p = 0.0063). CONCLUSION Our data indicate that extensive retroperitoneal tissue clearance does not improve long-term survival rates compared to regional lymphadenectomy restricted to the right side of the mesenteric artery.