PANCREATIC INVASION AS THE PROGNOSTIC INDICATOR OF DUODENAL ADENOCARCINOMA TREATED BY PANCREATICODUODENECTOMY PLUS EXTENDED LYMPHADENECTOMY

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 in dicator showing, if possible before laparotomy, which instances are no ncurable by surgery alone or need adjuvant therapies. Methods. A retro spective analysis was made for 24 consecutive patients whose duodenal adenocarcinomas were treated by pancreatoduodenectomy plus a wide rang e 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 surv ival rate was 69% at 3 years and 57% at 5 years; locoregional recurren ce was the primary cause of death. Although the 5-year survival rate w as 44% in patients with nodal involvement and 76% in those without, th is difference did not reach statistical significance (P =.079). Instea d, invasion into the pancreatic parenchyma at a macroscopic level was the most significant prognostic factor; the 5-year survival rate was 7 8% in the 16 patients without and 16% in the 8 patients with pancreati c invasion (P =.0047). Invasion into the pancreas correlated well with the angiographic findings; the 5-year survival rate was 25% in patien ts whose angiograms delineated the pancreatic invasion and 83% in pati ents 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 mos t associated with patient survival. Pancreatic invasion was well delin eated by the preoperative angiogram, which would be helpful in patient selection.