Total pancreatectomy for ductal adenocarcinoma of the pancreas with special reference to resection of the portal vein and multicentric cancer

Between March 1, 1968 and March 1, 1986, 323 patients underwent surgery for cancer of the pancreas or the periampullary region. Extirpative procedures were performed in 91 patients, of whom 51 had ductal carcinoma of the pancreas. Forty‐seven patients had total pancreatectomy, 9 associated with rese...

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Bibliographic Details
Published in:World journal of surgery 1993-01, Vol.17 (1), p.122-126
Main Authors: Launois, B., Franci, J., Bardaxoglou, E., Ramee, M. P., Paul, J. L., Malledant, Y., Campion, J. P.
Format: Article
Language:English
Subjects:
Adult
Aged
Carcinoma, Intraductal, Noninfiltrating - mortality
Carcinoma, Intraductal, Noninfiltrating - pathology
Carcinoma, Intraductal, Noninfiltrating - surgery
Ductal Carcinoma
Female
Humans
Male
Mese
Middle Aged
Neoplasms, Multiple Primary
Pancreatectomy
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Portal Vein
Portal Vein - surgery
Postoperative Complications
Resectability Rate
Survival Rate
Total Pancreatectomy
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Summary:Between March 1, 1968 and March 1, 1986, 323 patients underwent surgery for cancer of the pancreas or the periampullary region. Extirpative procedures were performed in 91 patients, of whom 51 had ductal carcinoma of the pancreas. Forty‐seven patients had total pancreatectomy, 9 associated with resection of the portal vein and 1 with total gastrectomy. Operative mortality was 15% but fell to zero for the 19 total pancreatectomies performed after 1981. With the introduction of total pancreatectomy, the resectability rate increased from 15% to 32%. Overall mean survival was 14.4 months. Actuarial survival was 42.4% at 1 year, 25.6% at 2 years, 11.9% at 3 years, and 8% at 5 years. Six patients are alive 7, 11, 14, 30, 30, and 73 months, respectively, after operation. Survival was calculated according to the classifications of Hermreck, Tryka and Brooks, and the TNM system. Ductal carcinoma was multifocal in 32% of patients, and 25% had epithelial dysplasia of the pancreatic duct. When portal vein resection was necessary, mean survival was 6.1 months, compared with 18.25 months when it was not performed. We conclude that total pancreatectomy has increased our resectability rate, mainly in patients with tumor spread beyond the usual margins of division for Whipple's procedure. However, the procedure does not appear worthwhile when portal vein resection is necessary or when multicentric cancer or neoplastic emboli are observed in the operative specimen. Résumé Entre le 1 Mars 1968 et le 1 Mars 1986, 323 patients ont été opérés d'un cancer du pancréas ou de la région périampullaire. Une exérèse a été réalisée chez 91 patients parmi lesquels 51 avaient un cancer glandulaire (adénocarcinome) du pancréas. Parmi ceux‐ci, 47 ont eu une pancréatectomie totale dont 9 combinées à une résection de la veine porte et une associée à une gastrectomie totale. La mortalité périopératoire a été de 13%, mais est tombée à 0% pour les 19 pancréatectomies totales réalisées après 1981. Lorsque la pancréatectomie totale a pu Être menée à bien, le taux de résecabilité est passé de 15% à 32%. La survie globale a été de 14.4 mois. La survie actuarielle a été de 42.4% à un an, de 25.6% à 2 ans, de 11.9% à 3 ans, et de 8% à 5 ans. Six patients sont en vie 7, 11, 14, 30, 30 et 73 mois après résection. La survie a été calculée en fonction de la classification de Hermreck, Tryka, Brooks et TNM. Le cancer était multifocal dans 32% des cas, et 25% des patients avaient une dysplasie épithéliale
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01655724