Pancreatic invasion as the prognostic indicator of duodenal adenocarcinoma treated by pancreatoduodenectomy plus extended lymphadenectomy

• Published in: Surgery 1998-09, Vol.124 (3), p.510-515
• Main Authors: Ohigashi, Hiroaki, Ishikawa, Osamu, Tamura, Sumito, Imaoka, Shingi, Sasaki, Yo, Kameyama, Masao, Kabuto, Toshiyuki, Furukawa, Hiroshi, Hiratsuka, Masahiro, Fujita, Makoto, Hashimoto, Tsutomu, Hosomi, Naohiro, Kuroda, Chikazumi
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Biological and medical sciences; Duodenal Neoplasms - mortality; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Female; Humans; Laparotomy; Lymph Node Excision; Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - secondary; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Predictive Value of Tests; Prognosis; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/S0039-6060(98)70097-2

Background: Pancreatoduodenectomy has become the standard procedure in resection of the duodenal adenocarcinoma, and some adjuvant therapies can be added to obtain further improvement in postoperative outcome. However, for patient selection, it is necessary to have a predictive indicator showing, if possible before laparotomy, which instances are noncurable by surgery alone or need adjuvant therapies. Methods: A retrospective analysis was made for 24 consecutive patients whose duodenal adenocarcinomas were treated by pancreatoduodenectomy plus a wide range of lymphadenectomies without any adjuvant therapies at Osaka Medical Center for Cancer and Cardiovascular Diseases. Patient survival rates were related to macroscopic and microscopic findings and to findings obtained by preoperative imaging techniques. Results: The overall survival rate was 69% at 3 years and 57% at 5 years; locoregional recurrence was the primary cause of death. Although the 5-year survival rate was 44% in patients with nodal involvement and 76% in those without, this difference did not reach statistical significance ( P = .079). Instead, invasion into the pancreatic parenchyma at a macroscopic level was the most significant prognostic factor; the 5-year survival rate was 78% in the 16 patients without and 16% in the 8 patients with pancreatic invasion ( P = .0047). Invasion into the pancreas correlated well with the angiographic findings; the 5-year survival rate was 25% in patients whose angiograms delineated the pancreatic invasion and 83% in patients whose angiograms did not ( P = .0084). Conclusions: When duodenal adenocarcinoma was treated by pancreatoduodenectomy plus a wide range of lymphadenectomy, pancreatic invasion at a macroscopic level was most associated with patient survival. Pancreatic invasion was well delineated by the preoperative angiogram, which would be helpful in patient selection. (Surgery 1998;124:510-15.)