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. 1992 Mar;215(3):231–236. doi: 10.1097/00000658-199203000-00006

Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein.

O Ishikawa 1, H Ohigashi 1, S Imaoka 1, H Furukawa 1, Y Sasaki 1, M Fujita 1, C Kuroda 1, T Iwanaga 1
PMCID: PMC1242425  PMID: 1543394

Abstract

This retrospective study attempted to determine the indications for extended pancreatectomy for locally advanced carcinoma of the pancreas, in terms of postoperative prognosis. An extended pancreatectomy with portal vein or superior mesenteric vein (PV/SMV) resection and regional lymphadenectomy was performed in 35 of 50 consecutive cancers that extended into the retroperitoneal spaces and involved the PV or SMV. Among the many background factors in the 35 resected specimens, the degree of PV/SMV invasion by the cancer was most closely associated with prognosis, despite resection of all involved PV/SMV. This factor generally correlated with the preoperative findings on the portal phase of superior mesenteric arteriograph. In 17 selected patients in whom PV/SMV invasion had been angiographically both semicircular or less and 1.2 cm (1.4 cm on the film) or less in length, the 3-year survival rate was 59%. This survival rate was significantly higher than the 29% 3-year survival rate in all 35 patients (p less than 0.05). Conversely, among the 18 patients in whom invasion was angiographically either beyond semicircular or more than 1.2 cm (1.4 cm on the film) in length, there were no 1.5-year survivors, and this result was even worse than that of 15 nonresectable cases. Based on postoperative survival, the degrees of PV/SMV invasion on preoperative angiography (narrowing pattern and length) are good indicators for aggressive pancreatectomy for locally advanced pancreatic cancer.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cohen J. R., Kuchta N., Geller N., Shires G. T., Dineen P. Pancreaticoduodenectomy. A 40-year experience. Ann Surg. 1982 May;195(5):608–617. doi: 10.1097/00000658-198205000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Crist D. W., Sitzmann J. V., Cameron J. L. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987 Sep;206(3):358–365. doi: 10.1097/00000658-198709000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dooley W. C., Cameron J. L., Pitt H. A., Lillemoe K. D., Yue N. C., Venbrux A. C. Is preoperative angiography useful in patients with periampullary tumors? Ann Surg. 1990 Jun;211(6):649–655. doi: 10.1097/00000658-199006000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fortner J. G. Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg. 1984 Apr;199(4):418–425. doi: 10.1097/00000658-198404000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Goldstein H. M., Neiman H. L., Bookstein J. J. Angiographic evaluation of pancreatic disease. A further appraisal. Radiology. 1974 Aug;112(2):275–282. doi: 10.1148/112.2.275. [DOI] [PubMed] [Google Scholar]
  6. Grace P. A., Pitt H. A., Tompkins R. K., DenBesten L., Longmire W. P., Jr Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg. 1986 Jan;151(1):141–149. doi: 10.1016/0002-9610(86)90024-3. [DOI] [PubMed] [Google Scholar]
  7. Ishikawa O., Ohhigashi H., Sasaki Y., Kabuto T., Fukuda I., Furukawa H., Imaoka S., Iwanaga T. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg. 1988 Aug;208(2):215–220. doi: 10.1097/00000658-198808000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Jones B. A., Langer B., Taylor B. R., Girotti M. Periampullary tumors: which ones should be resected? Am J Surg. 1985 Jan;149(1):46–52. doi: 10.1016/s0002-9610(85)80008-8. [DOI] [PubMed] [Google Scholar]
  9. Kalser M. H., Ellenberg S. S. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985 Aug;120(8):899–903. doi: 10.1001/archsurg.1985.01390320023003. [DOI] [PubMed] [Google Scholar]
  10. Morrow M., Hilaris B., Brennan M. F. Comparison of conventional surgical resection, radioactive implantation, and bypass procedures for exocrine carcinoma of the pancreas 1975-1980. Ann Surg. 1984 Jan;199(1):1–5. doi: 10.1097/00000658-198401000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Nakao A., Nonami T., Harada A., Kasuga T., Takagi H. Portal vein resection with a new antithrombogenic catheter. Surgery. 1990 Nov;108(5):913–918. [PubMed] [Google Scholar]
  12. Reichardt W., Ihse I. Percutaneous transhepatic portography in pancreatic carcinoma. Diagnosis and evaluation of resectability. Acta Radiol Diagn (Stockh) 1980;21(5):579–586. doi: 10.1177/028418518002100503. [DOI] [PubMed] [Google Scholar]
  13. SELDINGER S. I. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 1953 May;39(5):368–376. doi: 10.3109/00016925309136722. [DOI] [PubMed] [Google Scholar]
  14. Sindelar W. F. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg. 1989 Jan;124(1):127–132. doi: 10.1001/archsurg.1989.01410010137027. [DOI] [PubMed] [Google Scholar]
  15. Suzuki T., Kawabe K., Imamura M., Honjo I. Survival of patients with cancer of the pancreas in relation to findings on arteriography. Ann Surg. 1972 Jul;176(1):37–41. doi: 10.1097/00000658-197207000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Suzuki T., Tani T., Honjo I. Appraisal of arteriography for assessment of operability in periampullary cancer. Ann Surg. 1975 Jul;182(1):66–71. doi: 10.1097/00000658-197507000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Tepper J., Nardi G., Sutt H. Carcinoma of the pancreas: review of MGH experience from 1963 to 1973. Analysis of surgical failure and implications for radiation therapy. Cancer. 1976 Mar;37(3):1519–1524. doi: 10.1002/1097-0142(197603)37:3<1519::aid-cncr2820370340>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  18. Tsuchiya R., Noda T., Harada N., Miyamoto T., Tomioka T., Yamamoto K., Yamaguchi T., Izawa K., Tsunoda T., Yoshino R. Collective review of small carcinomas of the pancreas. Ann Surg. 1986 Jan;203(1):77–81. doi: 10.1097/00000658-198601000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Whittington R., Solin L., Mohiuddin M., Cantor R. I., Rosato F. E., Biermann W. A., Weiss S. M., Pajak T. F. Multimodality therapy of localized unresectable pancreatic adenocarcinoma. Cancer. 1984 Nov 1;54(9):1991–1998. doi: 10.1002/1097-0142(19841101)54:9<1991::aid-cncr2820540934>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  20. Zimmerman S. E., Smith F. P., Schein P. S. Chemotherapy of pancreatic carcinoma. Cancer. 1981 Mar 15;47(6 Suppl):1724–1728. doi: 10.1002/1097-0142(19810315)47:6+<1724::aid-cncr2820471444>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]

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