Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy

An aggressive strategy that includes extended lymphadenectomy and vein resection may improve the results of surgical treatment of pancreatic head cancer.

Nonrandomized control trial.

Tertiary care referral center.

The study included 149 consecutive patients undergoing macroscopically curative resection for periampullary adenocarcinoma from January 1, 1988, to December 31, 1998.

A standard resection was performed in 122 cases; an extended lymphadenectomy in 37. Twenty-four patients underwent venous resection.

Data on surgical mortality, morbidity, and postoperative outcome, pathological findings, and long-term survival were analyzed.

In-hospital and 60-day operative mortality was 5.4%. Morbidity was 37.5%. Mortality, morbidity, and postoperative stay were nonsignificantly modified by extended lymphadenectomy or venous resection. Extended resection permitted the identification of a significantly higher percentage of nodal metastases beyond the peripancreatic node groups. In patients undergoing vein resection, a significantly higher rate of positive retroperitoneal margin was found. In the 100 patients with ductal adenocarcinoma, the median overall survival and the 5-year actuarial survival rate were 15 months and 8.4%, respectively. A trend toward a better survival was observed in the first 2 years after operation in the extended resection group compared with the standard resection group. Nodal status was the most powerful predictor of overall survival by multivariate analysis.

Extended lymphadenectomy and vein resection did not adversely affect postoperative mortality and morbidity. Patients who required a vein resection were less likely to receive a microscopically curative pancreatectomy. Extended resection permitted better pathological staging and was associated with an early advantage in survival, but long-term survival was possible only in patients with favorable prognostic factors.