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Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences 6/2009

01.11.2009 | Original article

Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer?

verfasst von: Hodaka Amano, Fumihiko Miura, Naoyuki Toyota, Keita Wada, Ken-ichirou Katoh, Kouichi Hayano, Susumu Kadowaki, Makoto Shibuya, Sawako Maeno, Tomoaki Eguchi, Tadahiro Takada, Takehide Asano

Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences | Ausgabe 6/2009

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Abstract

Background/purpose

We often encounter unresectable pancreatic cancer due to invasions of the major vessels. Vascular resection for locally advanced pancreatic cancers has an advantage in en block local resection. There are potential cases in which good outcomes can be achieved by arterial resection.

Methods

Pancreatectomy (including total pancreatectomy in 15 cases, pancreatoduodenectomy in 7 cases and distal pancreatectomy in one case) was performed in 23 cases of invasive ductal carcinoma of the pancreas, in combination with resection and reconstruction of the hepatic artery in 15 cases, the superior mesenteric artery in 12 cases (there are overlaps) and the portal vein in 20 cases.

Results

The median operating time was 686 min (416–1,190 min) and the median blood loss was 2,830 ml (440–19,800 ml). This shows that the surgery was highly-invasive. The operative mortality rate was 4.3%. On the basis of the UICC classification, there were 2 cases of Stage IIa, 4 cases of Stage IIb, 9 cases of Stage III, 8 cases of Stage IV, while there were 18 cases (78.3%) of R0 resection. On the other hand, the final histological findings showed that there were 8 cases (34.8%) of M1 (liver and non-regional lymph node metastases), so it is thought that decisions on operative indications should be not be made slightly. As for the overall survival rate, the 1-year survival rate was 51.2% and the 3-year survival rate was 23.1% while the median survival time (MST) was 12 months. As for 15 cases of M0, the 1-year survival rate was 61.9% and the 4-year survival rate was 38.7% while the MST was 16 months. On the other hand, the MST was poor (10 months) in 8 cases of M1, showing that a statistically significant difference was observed depending upon the degree of metastasis (log-rank P = 0.0409). In 18 cases of R0, the 1-year survival rate was 67.2%, the 4-year survival rate 30.2% and the MST 13 months, respectively, while in 5 cases of R1 and R2, the MST was 6 months, showing that there was a statistically significant difference between R0 cases and R1, R2 cases (log-rank P = 0.0002).

Conclusions

Further discussion is required concerning surgical indications and significance. However, it is thought that resection is useful only when surgery of R0 has taken place for selected locally advanced pancreatic cancer (M0).
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Metadaten
Titel
Is pancreatectomy with arterial reconstruction a safe and useful procedure for locally advanced pancreatic cancer?
verfasst von
Hodaka Amano
Fumihiko Miura
Naoyuki Toyota
Keita Wada
Ken-ichirou Katoh
Kouichi Hayano
Susumu Kadowaki
Makoto Shibuya
Sawako Maeno
Tomoaki Eguchi
Tadahiro Takada
Takehide Asano
Publikationsdatum
01.11.2009
Verlag
Springer Japan
Erschienen in
Journal of Hepato-Biliary-Pancreatic Sciences / Ausgabe 6/2009
Print ISSN: 1868-6974
Elektronische ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0190-7

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