[Extensive radical surgery for carcinomas of the head of the pancreas]

Since 1973, we have applied extensive radical surgery for the head of the pancreas in order to improve not only the resection rate but also the surgical therapeutic results. The main points of our surgical procedure are as follows: (1) complete resection of surrounding connective tissues in retroperitoneum including extrapancreatic neural plexus. (2) extensive lymph node dissection, and (3) combined resection of the portal vein. As a result, our 3-year survival rate has increased to 31.4% and the 5-year survival rate to 27.9% in patients who underwent the macroscopically complete resection. These surgical therapeutic results are not satisfactory, but we have had 10 patients who survived more than 3 years. It is also true, however, that this procedure is extremely invasive and requires careful, long-term nutritional management after surgery. Therefore, the cooperation of not only the patients themselves but also their families is indispensable for the success of the treatment.