Surgery for ductal adenocarcinoma of the pancreatic head: Staging, complications, and survival after regional versus extended lymphadenectomy

The purpose of this study was to evaluate the influence of regional versus extended Lymphadenectomy on survival after partial pancreaticoduodenectomy for pancreatic cancer. From October 1988 to December 1991 (Department of Su rgery, University of Hamburg) and from January 1992 to March 1998 (Departme nt of Surgery, University of Kiel) 72 patients with histologically proven d uctal adenocarcinoma of the pancreatic head were treated. Partial pancreati coduodenectomy with regional lymphadenectomy was performed in 26 patients. In 46 patients lymphadenectomy was expanded to include extended retroperito neal lymphatic and connective tissue clearance. Comparing these two groups and including only patients with R0 resections (n = 58) no significant diff erences in Long-term survival could be shown. The following parameters were shown to have a significant or nearly significant influence on long-term s urvival: (1) stage of the disease: The 5-year survival of patients with sta ge I/II pancreatic head cancer was 63%, compared to 15% in patients with st age III/IV a + b of the disease (p = 0.0087). (2) Grading: The 1-year survi val of patients with well or moderately differentiated tumors was 55%, comp ared to 0% for patients with poorly differentiated ductal adenocarcinoma (p = 0.0022). (3) N stage: The 5-year survival of patients in N0 stage was 46 .9%, compared with 15% for N1 stage patients. The difference was not quite significant (p = 0.081). (4) Portal vein involvement: The 1-year survival w as 0% in patients with R0 resections and histologically proven tumor infilt ration of the portal vein, compared to 63% for patients with curative resec tions without portal vein involvement (p = 0.0063). In conclusion our data indicate that extensive retroperitoneal tissue clearance during pancreatico duodenectomy for ductal pancreatic cancer does not improve survival compare d to regional lymphadenectomy restricted to the right side of the mesenteri c artery.