Locoregional dissemination and extended lymphadenectomy in pancreatic cancer

Carcinoma of the pancreas is characterized by the high frequency of intrapa ncreatic (from 75 to 100%) and extrapancreatic neural invasion (from 64 to 69%). Even small-sized tumors (T-1) show plexus invasion. Carcinoma of the pancreas is also associated with a high incidence (76%) of lymph node metas tasis. The knowledge of local and regional tumor spread is mandatory in the planning of rational surgical treatment with the intention to cure. At pre sent, it does not seem possible to predict the direction of lymph drainage leading to nodal involvement in different anatomical areas. However, the an terior and posterior pancreaticoduodenal areas are generally involved at fi rst and nodes farther away from the primary tumor mostly show metastases on ly after involvement of the nearer nodes. We believe, radical pancreatoduod enectomy should be based on three aspects: wide lymph node dissection; radi cal retroperitoneal dissection, and pancreatectomy with an extirpation line left of the coeliac axis for tumors of the head and left pancreatectomy fo r tumors of the body and tail of the pancreas. Conclusions: Cure or long-te rm palliation of pancreatic cancer is generally possible only after complet e erradication of the primary tumor, including its local and regional exten sions.