Surgical Treatment Of Ductal Adenocarcinoma In The Head Of The Pancreas

The prognosis for patients with carcinoma of the pancreatic head area has been poorest for patients with gastrointestinal tract malignancy. It is difficult to diagnosis in its early stage, so that there is a few patients underwent curative resection. High risk of the operation, lower resectability rate and lower long-term survival become the distinct characters of the curative operation. The emphasis of pancreas surgery is to improve resectability rate, safety of operation, and survival rate.High resectability rate is the basis to improve the survival rate of cancer in the head of the pancreas. The significant accumulated experience to decrease the mortality and morbidity helps improving the safety of the operation, and the experience to cope with the involved vessels also helps improving the resectability rate.But the survival rate of resection of cancer is really lower with the 5-year rate in the range of 5 to 10 percentage. Lymph node metastasis is one of the most important prognostic factors, so that it is necessary to perform regional lymphadenectomy in pancreaticoduodenectomy. In this study, we discuss the way to decrease the mortality and morbidity, and the way to improve the resectability rate. The influence factors of safety and respectability were analyzed. On the basis of classic pancreaticoduodenectomy (Whipple procedure),we analysis the characters of lymph node metastasis of cancer in the head of the pancres. We expect to improve the long-term survival rate of the patient underwent pancreaticodudenectomy by extending the resected area and performing the regional lymphadenectomy. The main work is described as follows: 1.The resectability and safety of resection of cancer in the head of the pancreasObjective; We review the recent experience with resected cancer in the head of the pancreas, and discuss the way to improving the resectability and safety of the resection procedure. Methods: The experience with 672 patients (1990-2000) undergoing pancreatic resection was retrospective analyzed. The pre- and post- operation situation of patients, pathology of tumor, resectability rate, morbidity and mortality were reviewed and analyzed. Results: 282 cases underwent resection procedure, which included classic Whipple procedure, pancreaticoduodenectomy en bloc resection with involved vessel, pancreaticoduodenectomy with regional lymphadenectomy and extended retroperitoneal resection, and total pancreatetomy. The palliative procedures were performed in the other 390 cases, which included cholangio- or cholecystojejunostomy, gastrojejunostomy, and laprotomy. The involvement rate of main vessels around pancreatic head area was significant higher in palliative cases than in resected cases (P<0.01). It had a negtive relationship between the resectability rate and the tumor size. The causes of the unresected tumor included vessel involvement, unmovable mass with retroperitonealinvolvement, long-distance metastasis and poor systemic situation. In 282 cases undergoing resection procedure, 41 cases occurred postoperative complication with a 14.5% morbidity. 17 cases died of severe complication, and the mortality was 6%. Conclusion: The resection procedure for cancer in the head of the pancreas is safe, and the morbidity and mortality is under control. The resectability rate of tumor is related with vessel involvement and retroperitoneal involvement considerably. Enhancing the management of involved vessel could improve the resectability rate of tumor in T2 and T3 stage effectively.2.The use of regional lymphadenectomy in the radical resection of the ductal adenocarcinoma in the head of the pancreas.Objective: To prospective study the safety and effect of regional lymphadenectomy in pancreaticoduodenectomy in the treatment of cancer in the head of the pancreas. Methods: On the basis of routine pancreaticoduodenectomy (Whipple procedure), we performed the regional lymphadenectomy which consisting of radical retroperitoneal dissection from the celiac trunk to the inferior mesenteri...