REOPERATIVE PANCREATICODUODENECTOMY

Objective The preoperative diagnostic strategy and operative technique for reoperative pancreaticoduodenectomy were outlined and operative m ortality, perioperative morbidity, and early survival data in carefull y selected patients undergoing reoperation for pancreatic cancer were analyzed. Summary Background Data Many patients with localized, nonmet astatic cancer of the pancreas undergo exploratory surgery with limite d preoperative assessment of resectability. Frequently, pancreaticoduo denectomy is not performed because cytologic or histologic proof of di agnosis is lacking, or tumor resectability is questioned. Many patient s are denied reoperation and a potentially curative resection because of the unacceptable morbidity and mortality believed to accompany panc reaticoduodenectomy in the reoperative setting. Methods Twenty-three p atients who had undergone previous surgery for palliation or diagnosis of a pancreatic head mass were reoperated on after a standardized pre operative imaging evaluation consisting of chest radiography, computed tomography, and visceral angiography. A standardized operative techni que was used on all patients, but was modified based on altered anatom y from the initial operation. Results Based on preoperative imaging st udies, 19 of the 23 patients believed to have resectable tumors underw ent laparotomy for planned pancreaticoduodenectomy; resection was acco mplished in 14 patients. Seven of the fourteen patients required exten ded resections that included the superior mesenteric vein, right colon , or both. There was no perioperative mortality, and early complicatio ns occurred in 3 of the 14 resected patients. Four patients underwent planned palliative procedures. Four of ten patients who underwent rese ction for adenocarcinoma are without evidence of disease at a median f ollow-up of 26 months. Conclusions Reoperative pancreaticoduodenectomy can be performed safely and may result in prolonged survival in caref ully selected patients with resectable, localized pancreatic cancer.