Diagnosis of tumor extension of ductal adenocarcinoma of the pancreas based on histological findings

: This study was undertaken to evaluate the diagnosis for tumor extension of ductal adenocarcinoma of the head of the pancreas based on histological investigation. From 1968 to 1995, 316 patients underwent radical resection and histological tumor extension was quite as follows; the rate of invasion to the anterior pancreatic capsule was 49%, invasion to the retroperitoneal tissue was 77%, invasion to the portal vein system was 38%, invasion to the extrapancreatic nerve plexus was 53% and lymph node metastases were 79%. 249 patients was performed extended radical operation consisted of regional lymphadenectomy, retroperitoneal dissection and resection of portal vein system, however non-curative resection was 52% with tumor invasion to dissected pancreatic surface in 88% of non-curative patients. And there was no 5-year survivor with non-curative resection. The extended radical operation should be indicated for patients who will have curative resection. Then, we set up clinical stage (CS; CSI approximately IV) by three factors related to resectability mostly; invasion to retroperitoneal tissue (RP), invasion to portal vein system (PV), invasion to major arterial system (A). It was also set up preoperative diagnostic criteria for RP, PV and A factor by computed tomography (CT) or abdominal angiography. From 1989 to 1995, 101 patients who had extended radical operation were investigated prospectively. The rate of accuracy of preoperative diagnosis of tumor extension were about 80% in each factor. Curability was 94% in CS I, 67% in CS II, 43% in CS III, respectively, and 3-year survival rate was 53% in CS I, 35% in CS II, 2-year survival rate was 8% in CS III. However, in CS IV the rate of non-curative resection was 77% and there was no 2-year survivor. It was concluded that extended radical operation of ductal adenocarcinoma of the head of the pancreas should be indicated for patients in less than CS III diagnosed by CT or angiography preoperatively.