A comparative study of pancreatectomy and pancreas-preserving gastrectomy in advanced gastric carcinomas

In patients with advanced gastric carcinoma (tumor infiltrating beyond submucosal layer), distal pancreatectomy has been frequently performed simultaneously with gastrectomy for complete removal of the lymph nodes along the splenic artery. However, the possibility of a negative impact has also been reported. To evaluate the effects of distal pancreatectomy with gastrectomy for patients with advanced gastric cancer, we retrospectively analyzed 84 patients who had proximal- or middle-third advanced gastric cancer resected in an institution in Taiwan.

From 1988 to 1998, 46 patients who underwent gastrectomy with distal pancreatectomy (DP group) and 38 patients who had pancreas-preserving gastrectomy (PS group) for advanced gastric cancer were reviewed. The clinicopathological details and survival rates were compared between the two groups.

In terms of clinicopathological factors and operative mortality, there were no significantly statistical differences between the patients who did and did not undergo distal pancreatectomy. The cumulative 5-year survival rate for the DP group was 35.6%, whereas the 5-year survival rate for the PS group was 42.4% (P=0.6224). In contrast, the operative morbidity was significantly higher in patients who had distal pancreatectomy (P=0.008).

Since distal pancreatectomy does not benefit patients with advanced gastric cancer, this procedure should not be regarded as routine in a radical resection.