An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging

• Published in: Cancer Vol. 72; no. 7; pp. 2118 - 2123
• Main Authors: Kayahara, Masato, Nagakawa, Takukazu, Ueno, Keiichi, Ohta, Tetsuo, Takeda, Toshiya, Miyazaki, Itsuo
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.10.1993; Wiley-Liss
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adenocarcinoma, Papillary - diagnostic imaging; Adenocarcinoma, Papillary - pathology; Adenocarcinoma, Papillary - surgery; Adult; Aged; Aged, 80 and over; Autopsy; Biological and medical sciences; Female; Gastroenterology. Liver. Pancreas. Abdomen; hepatic metastasis; Humans; Liver Neoplasms - secondary; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Neoplasm Metastasis - pathology; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplastic Cells, Circulating; Pancreatectomy; pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; perineural invasion; radical resection; Radiography; Retroperitoneal Neoplasms - secondary; retroperitoneal recurrence; Tumors; Human; Relapse; Carcinoma; Radical resection; Treatment; Follow up study; Surgery; Digestive diseases; Malignant tumor; Metastasis; Pancreatic duct; Pancreatic disease
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19931001)72:7<2118::AID-CNCR2820720710>3.0.CO;2-4

Background. To determine the extent of dissection in curative resection for cancer of the pancreatic head, the mode of recurrence was determined at autopsy and by radiographic examinations. Materials and Methods. Records of 45 patients who had undergone macroscopically curative resection of carcinoma of the head of pancreas were analyzed to determined the mode of recurrence. The mode of recurrence was divided into four types: hepatic metastasis, peritoneal dissemination, retroperitoneal recurrence, and distant metastasis. Retroperitoneal recurrence was subdivided into lymph node metastasis and local recurrence, primarily neural invasion and lymphatic invasion. Results. Thirty patients experienced disease recurrence. Patients with Stage I or II disease experienced recurrence significantly less often than did patients with Stage III or IV disease (P < 0.05). Local retroperitoneal recurrence was discovered in 12 of 15 (80%) postmortem examinations, hepatic metastasis in 10 (66%), peritoneal dissemination in 8 (53%), and lymph node recurrence in 7 (47%). In 15 antemortem studies, retroperitoneal recurrence occurred most frequently (87%), followed by hepatic metastasis (53%). Almost all patients with liver metastasis also had local retroperitoneal recurrence. Conclusions. The frequency of retroperitoneal recurrence of carcinoma of the head of the pancreas suggests that retroperitoneal resection, including nerve plexi and lymph nodes, should be included in curative resections for patients with Stage I or II pancreatic cancer.