Extended resection for pancreatic adenocarcinoma

Srinevas K. Reddy, Douglas Tyler, Theodore N. Pappas, Bryan M. Clary

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Adenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term outcomes after pancreaticoduodenectomy (PD), many surgeons have sought to improve survival via a radical or "extended" pancreatectomy which may include (a) total pancreatectomy (TP), (b) extended lymph node dissection (ELND), and (c) portal/mesenteric vascular resections. These themes of "extended" resection are addressed in this review. TP should not be performed for most cases of adenocarcinoma of the pancreatic head because of the nominal incidence of lymph node involvement along the body and tail of the pancreas, the scarcity of multicentric disease, and the better management of pancreatic leaks after PD. Most studies show no difference in long-term survival and demonstrate greater postoperative morbidity after TP than after PD. Performing ELND in addition to PD is not worthwhile because most studies do not demonstrate any long-term benefits from ELND and the circumferential dissection around the mesenteric vessels required to harvest distant lymph nodes increases postoperative morbidity. Major arterial resection increases postoperative morbidity after PD and worsens long-term survival as the need for arterial resection to achieve negative resection margins indicates more aggressive disease. In contrast, portal and/or mesenteric venous resection does not increase the morbidity after PD or impact long-term survival as venous resection is often performed because of tumor location and not extent of disease. The disappointing experience with extended resections underscores the need for better adjuvant systemic strategies and the interdisciplinary care of patients with pancreatic adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)654-663
Number of pages10
JournalOncologist
Volume12
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Adenocarcinoma
Pancreatectomy
Lymph Node Excision
Morbidity
Pancreas
Lymph Nodes
Disease Management
Blood Vessels
Dissection
Patient Care
Incidence
Neoplasms

Keywords

  • Pancreatectomy lymph node excision
  • Pancreatic ductal carcinoma
  • Pancreatic neoplasms
  • Pancreaticoduodenectomy
  • Portal vein

ASJC Scopus subject areas

  • Cancer Research
  • Hematology

Cite this

Extended resection for pancreatic adenocarcinoma. / Reddy, Srinevas K.; Tyler, Douglas; Pappas, Theodore N.; Clary, Bryan M.

In: Oncologist, Vol. 12, No. 6, 06.2007, p. 654-663.

Research output: Contribution to journalArticle

Reddy, Srinevas K. ; Tyler, Douglas ; Pappas, Theodore N. ; Clary, Bryan M. / Extended resection for pancreatic adenocarcinoma. In: Oncologist. 2007 ; Vol. 12, No. 6. pp. 654-663.
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