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SURGICAL MANAGEMENT OF CARCINOMA OF THE HEAD OF PANCREAS: EXTENDED LYMPHADENECTOMY OR MODIFIED EN BLOC RESECTION?
Author(s) -
Samra Jaswinder S.,
Gananadha Sivakumar,
Hugh Thomas J.
Publication year - 2008
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2008.04426.x
Subject(s) - medicine , lymphadenectomy , surgery , pancreas , resection , pancreatic head , carcinoma , pancreatectomy , pancreatic cancer , pathological , general surgery , cancer
Pancreatoduodenectomy for the treatment of periampullary cancer was described over 70 years ago. The technique has evolved in an attempt to improve the dismal prognosis for patients with pancreatic cancers. Radical regional resection has been proposed to decrease the incidence of local recurrence as well as to improve survival. These extended resections have failed to show a significant survival benefit in prospective randomized controlled studies. Furthermore, extended pancreatic resections may be associated with increased morbidity. The concept of modified en bloc resection has been advocated and is soundly based on anatomical and pathological principals. This procedure is a modification of the radical regional resection previously described. It involves resection of the peripancreatic retroperitoneal tissue and lymph nodes en bloc with the head of pancreas, in order to achieve an R0 resection but without the morbidity associated with an extended lymphadenectomy. Conceptually, this procedure may be the most appropriate technique for the management of pancreatic head cancers although the ultimate effect on long‐term survival can only be judged after further clinical studies.