Does the extent of lymphadenectomy have impact on the prognosis of patients with pancreatic cancer?

Accessible online at: www.karger.com/journals/onk Fax +49 761 4 52 07 14 E-mail [email protected] www.karger.com Tumors of the pancreatic head are treated with partial duodenopancreatectomy, tumors of the corpus/tail region with a left-sided pancreatic resection and splenectomy. Because of consequently arising problems in connection with complete exoand endocrinological insufficiency, a total pancreatectomy is only indicated when the entire pancreas is involved. Since isolated resection of the pancreatic tumor could not improve long-term survival, over the last 15 years surgical procedures were extended. Operations including intraand retroperitoneal lymphadenectomies were performed. This extension of the surgical procedure is (among others) based on the findings of Ishikawa et al. [4], who in 1988 described that patients with a resectable pancreatic head carcinoma showed an improvement in the 5-year survival time from 9 to 28% after radical intraand retroperitoneal lymphadenectomy. For our own operative strategy we distinguish between regional and extended retroperitoneal lymphadenectomy. Regional lymphadenectomy includes resection of the pancreatic head with removal of all lymphatic tissue at the hepatoduodenal ligament, the hepatic artery, the celiac trunk, the first 3 cm of the splenic artery, the right side of the superior mesenteric artery, and the ventral surface of the vena cava and the renal veins. During extended retroperitoneal lymphadenectomy (as described by Ishikawa et al. [4]) all lymphatic, connective and neural tissues at the aorta between the inferior mesenteric artery and the coeliac trunk as well as the left side of the superior mesenteric artery are additionally resected. Recently published studies [5] as well as our own data [6] do not allow a definitive conclusion regarding the prognostic impact of extended retroperitoneal resection on the prognosis of the patients. The analysis of the prognostic factors for longterm survival in our own 72 patients with ductal adenocarcinoma of the pancreatic head operated between 1988 and 1998 (regional LA n=26, extended LA n=46) could not demonIntroduction