[Significance of extensive surgery in pancreatic cancer]

The pancreas is located in the retroperitoneal space, and its anatomical position is very important in devising a rational surgical approach to pancreatic cancer. In cancer of the pancreas head, cancer cells could invade the portal vein and perineural space of the celiac plexus, and metastasize to regional lymph nodes around the celiac axis. For these reasons, we have performed on extensive operation for cancer of the pancreas head, in which a pancreaticoduodenectomy was performed with extensive resection of the regional lymph nodes around the celiac axis, resection of the celiac plexus and segmental resection of the portal vein. As a result, seven out of 31 resected cases survived more than 5 years after the operation. On the other hand, local recurrence was still found at autopsy in 11 of 12 patients who underwent the extensive operation and died of the recurrent disease. Therefore, further removal of adjacent tissues behind the pancreas and extensive dissection of the regional lymph nodes around the celiac axis seem important for improving the survival of patients with cancer of the pancreas head. Postoperatively, skillful management is also required for severe intestinal malabsorption and diabetic state following the operation.