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Intermediate results of extended pancreaticoduodenectomy. Verona experience
Author(s) -
Iacono C.,
Facci E.,
Bortolasi L.,
Zamboni G.,
Scarpa A.,
Talamini G.,
Prati G.,
Nifosí F.,
Serio G.
Publication year - 1999
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s005340050086
Subject(s) - medicine , pancreaticoduodenectomy , stage (stratigraphy) , carcinoma , survival rate , cancer , pancreas , surgery , radiology , general surgery , paleontology , biology
Abstract Background Extended pancreaticoduodenectomy (EPD) with retroperitoneal lymphatic, neural, and connective clearance has been proposed to improve survival in patients with carcinomas of the head of the pancreas. The open questions are: does EPD allow better staging of the tumor? Does it reduce local recurrences? And does it improve survival? Method We treated 26 patients by EPD between January 1994 and September 1996. Eighteen patients had pancreatic ductal carcinoma, 7, periampullary carcinoma; and 1, intraductal papillary mucinous carcinoma. Results The pancreatic cancers were International Union against Cancer (UICC) stage I in 3 patients, stage III in 14, and stage IV in 1. Two patients with stage III disease would have been considered as having stage I without EPD. Pancreatic cancer and periampullary carcinoma patients had a 3‐year actuarial survival of 32% and 86%, respectively. At a mean follow‐up time of 22.5 months (range, 6—39 months), 3 pancreatic cancer patients (16.6%) had loco‐regional recurrences, 6 patients (33%) had distant metastases, and 1 (5.5%) had distant and loco‐regional recurrences. Only 1 of 7 patients with periampullary carcinoma had distant metastasis 20 months after resection. Conclusion EPD seems to decrease the rate of local recurrences and allows more correct staging. The intermediate survival results are encouraging but a definitive conclusion awaits longer follow‐up.