D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer

Background/Aims: The aim of this study was to evaluate the influence of sta ndard pancreatoduodenectomy versus pancreatoduodenectomy with extended lymp hadenectomy and the role of adjuvant therapy on survival in patients with d uctal adenocarcinoma of the pancreatic head. In addition the problems relat ed to resection are discussed. Methodology: A total number of 124 pts operated on between 1985 and 1999 we re divided into three groups according to our different strategies. Standar d resection (D1) was performed on 48 patients (group A), extended resection (D2) on 45 patients (group B) and combined treatment (extended resection p lus adjuvant therapy) on 31 patients. The outcome of these three groups was compared with regard to postoperative morbidity and survival. Results: There was no significant difference in terms of survival between g roup A and B, while adjuvant therapy (group C), achieved statistical signif icance as factor influencing survival, together with tumor stage. Conclusions: Our data suggest that no further improvement can be obtained o n long-term survival by extended retroperitoneal dissection while chemoradi otherapy showed a doubling of median survival.