Extensive Gastropancreatoduodenal Resections in the Treatment of Ductal Carcinoma of the Head of Pancreas

The aim of the investigation is to estimate short- and long-term results of the treatment of ductal adenocarcinoma of the head of pancreas after conventional and extensive pancreatoduodenal resection.

Materials and Methods. There were performed total 27 conventional and 27 extensive interventions. The groups under study were comparable by sex, age, and the degree of tumour differentiation. Mean time of surgery, the volume of blood loss and hemotransfusion, the frequency of postoperative complications, and mortality did not differ significantly.

Results. After extensive pancreatoduodenal resection, local recurrence occurred significantly more rarely (7.4 versus 33.3% after conventional surgery). Broadened lymphadenectomy in ductal adenocarcinoma of the head of pancreas did not lead to the increase of postoperative complications, mortality and overall survival. In the meantime, extensive gastropancreatoduodenoal resection enables to decrease significantly recurrence rate.

1. Patyutko Yu.I., Kotel’nikov A.G. Khirurgiya raka organov biliopankreatoduodenal’noy zony [Surgery of cancer of biliopancreatoduodenal organs]. Moscow: Meditsina; 2008; 448 р.
2. Statistika zlokachestvennykh novoobrazovaniy v Rossii i stranakh SNG v 2004 godu. Pod. red. Davydova M.I., Aksel’ E.M. [Statistics of malignancies in Russia and CIS countries in 2004]. Davydova M.I., Aksel’ E.M. (editors). Vestn Ross Onkol Naucn centra im NN Blohina RAMN — Herald of Russian Oncological Scientific Centre named after N.N. Blokhin of RAMS 2006; 3(17, Suppl 1); 132 p.
3. Kubyshkin V.A., Vishnevskiy V.A. Rak podzheludochnoy zhelezy [Pancreatic cancer]. Moscow: Medpraktika-M; 2003; 380 p.
4. Japan Pancreas Society. National Pancreatic Cancer Registry, Japan: a report of 20 years. Suizo J Jpn Pancreat Soc 2003; 18: 101–169.
5. Ishikawa O., Ohigashi H., Sasaki Y. et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988; 208: 215–220.
6. Nagakawa T., Nagamori M., Futakami F. et al. Results of extensive surgery for pancreatic carcinoma. Cancer 1996; 77: 640–645.
7. Manabe T., Ohshio G., Baba N. et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 1989; 64: 1132–1137.
8. Pedrazzoli S., di Carlo V., Dionigi R. et al. Standard versus extended lymphadenectomy associated with pancreaticoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas. A multicenter, prospective, randomized study. Ann Surg 1998; 228: 508–517.
9. Yeo C.J., Cameron J.L., Lillemoe K.D. et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended rertoperitoneal lymphadenectomy for periampullary adenocarcinoma. Part 2. Randomized controlled trial evaluating survival, morbidity and mortality. Ann Surg 2002; 326: 355–368.
10. Nimura Y., Nagino M., Kato H. et al. Regional versus extended lymph node dissection in radical pancreatoduodenectomy for pancreatic cancer. A multicenter, randomized controlled trial. HPB 2004; 6(Suppl 1): 2.
11. Farnell M.B., Pearson R.K., Sarr M.G. et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surg 2005; 138: 618–630.
12. Srinevas K.R., Douglas S.T., Theodore N.P., Bryan M.C. Extended resection for pancreatic adenocarcinoma. The Oncologist 2007; 12: 654–663.
13. Granov A.M., Maystrenko D.N., Polysalov V.N. Klin Med — Clinical Medicine 2011; 1: 70–74.
14. Rebrova O.Yu. Statisticheskiy analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm STATISTICA [Statistical analysis of medical data. STATISTICA application program package]. Moscow: Mediacfera, 2002.
15. Pessaux P. External stent can help pancreaticoduodenectomy outcome. Ann Surg 2011; V 1.
16. Delcore R., Thomas J.H., Pierce G.E., Hermreck A.S., Pancreatogastrostomy: а safe drainage procedure after pan-creatoduodenectomy. Surg 1990; 108: 641–645.
17. Kapur B.M. Pancreaticogastrostomy in pancreaticoduodenal resection for ampullary carcinoma: Experience in thirty one cases. Surg 1986; 100: 489–493.
18. Icard P., Dubois F. Pancreaticogastrostomy following pancreatoduodenectomy. Ann Surg 1988; 207: 253–256.
19. Egorov V.I., Vishnevskiy V.A., Kozlov I.A. et al. Ann Hir Gepatol — Records of Surgery and Hepatology 2008; 13: 24–28.
20. Kawai M., Tani M., Hirono S., Shimizu A. Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy. Ann Surg 2011; 253(3): 495–501.
21. Fortner J.G., Kim D.K., Cubilla A. et al. Regional pancreatectomy: En bloc pancreatic, portal vein and lymph node resection. Ann Surg 1977; 186: 42–50.
22. Fortner J.G., Klimstra D.S., Senie R.T., Maclean B.J. Tumor size is the primary prognostic factor for pancreatic cancer after regional pancreatectomy. Ann Surg 1996; 223: 147–153.
23. Ishikawa О., Ohigashi H., Sasaki Y. et al. Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surg 1997; 121: 244–249.
24. Tarasov V.A., Pobegalov E.S., Stavrovietskiy V.V., Blyum M.B. Prakticheskaya onkologiya — Practical Oncology 2004; 2: 115–125.

Kuchin D.M., Gorokhov G.G., Vasenin S.А., Shalapuda V.I., Zarechnova N.V., Rykhtik P.I., Zagainov V.Е. Extensive Gastropancreatoduodenal Resections in the Treatment of Ductal Carcinoma of the Head of Pancreas. Sovremennye tehnologii v medicine 2012; (3): 54