Regional Pancreatectomy for Cancer of the Pancreas, Ampulla, and Other Related Sites

Abstract

Regional pancreatectomy refers to an en bloc removal of a tumor in or adjacent to the pancreas with an adequate soft tissue margin and with its regional lymphatic drainage. The pancreatic segment of portal vein is part of the en bloc resection with venous reconstruction by end-to-end anastomosis without a graft. This operation, called a type I regional pancreatectomy, may utilize either a total or subtotal removal of the pancreas. Localized arterial involvement by a neoplasm necessitates adding a segmental resection of the artery with vascular reconstruction, a type II procedure. A total of 61 patients had this procedure from 1972 through 1982. They are a subset of the 270 patients with cancer of the pancreas, ampullary and periampullary regions, duodenum or terminal portion of the common bile duct who were treated by the author during this period. The 61 consist of 35 patients who had an infiltrating duct adenocarcinoma of the pancreas and 21 who had other kinds of malignant tumors. In addition, 4 were classified as having pancreatitis and a 5th patient had a pseudolymphoma. The resectability rate is about 30%. The present operative mortality rate is 8%. Approximately 1/3 of the patients are alive; 43% of the 21 patients with malignant tumors other than infiltrating duct adenocarcinoma of the pancreas are alive with a median survival time of 40 mo. (3-92 mo.). A total of 43% were stage I but > 1/2 were T3 or T4 lesions. Of patients with stage II or III, 20% are alive. Some 20% of patients with infiltrating duct carcinoma of the pancreas are presently alive, 28% died of recurrent disease and 26% died of other causes; > 90% of these patients had advanced stage disease (stage II or II).