Abstract
Radical lymphadenectomy has been performed since the late 1970s, especially in the surgical departments of Japanese universities. Excellent results were reported for extended lymphadenectomy in gastric and oesophageal cancer when wide local excision was combined with systematic extended lymph node dissection. Overall 5-year survival of over 50% for the large number of patients undergoing gastric resection for cancer seems to demonstrate convincingly the value of the extended lymphadenectomy. All Oriental studies published to now are uncontrolled as are most reports from Western countries. The role of extended lymphadenectomy is therefore far from certain. On the other hand there is evidence that extended lymph node dissection in the treatment of pancreatic cancer might be of benefit to patients with small stage I and II tumours (1). All available data from published studies suggest that lymph node involvement is an important prognostic factor in patients with carcinoma of the head of the pancreas. Lymph node metastases occur in as many as 50% of the cases of even the smallest pancreatic cancers now being diagnosed and resected, especially those less than 2 cm in diameter (2). Classification of the critical areas of lymph node dissection in patients with carcinoma of pancreatic head show that perigastric lymph node involvement is found at about 14%. Para-aortic lymph node involvement in these patients is about 26% (3). Studies with radioactive colloids to determine lymphatic spread from the head of the pancreas to the para-aortic lymph nodes (area 16) showed that the main lymphatic route was found to pass through the nodes of the posterior region of the head of the pancreas (area 13) and around the superior mesenteric artery (area 14).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Taat CW, van Laschot JJ, Gouma DJ, Obertop H (1995) Role of extended lymph node dissection in the treatment of gastrointestinal tumours: a review of the literature. Scand J Gastroenterol 212(Suppl):109–116.
Reber HA, Ashley SW, McFadden D (1995) Curative treatment for pancreatic neoplasms. Radical resection. Surg Clin North Am 75:905–912.
Nakao A, Harada A, Nonami T et al. (1995) Lymph node metastases in carcinoma of the head of the pancreas region. Br J Surg 82:399–402.
Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, Miyazaki I (1994) Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 73:1155–1162.
Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I (1993) An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer 72:2118–2123.
Ishikawa O, Ohigashi H, Imaoka S et al. (1992) Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg 215:231–216.
Ozaki H, Kinoshita T, Kosuge T et al. (1996) An aggressive therapeutic approach to carcinoma of body and tail of the pancreas. Pancreas 77:2240–2245.
Nagakawa T, Nagamori M, Futakami F et al. (1996) Results of extensive surgery for pancreatic carcinoma. Cancer 77:640–645.
Takahashi S, Ogata Y, Miyazaki H et al. (1995) Aggressive surgery for pancreatic duct cell cancer: feasibility, validity, limitations. World J Surg 19:653–659.
Manabe T, Ohshio G, Baba N et al. (1989) Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 64:1132–1137.
Miyazaki I (1989) Significance of extensive surgery for pancreatic cancer. Gan To Kagaku Ryoho 16:1064–1069.
Ishikawa O, Ohhigashi H, Sasaki Y et al. (1988) Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 208:215–220.
Burcharth F, Andersen HB, Brahe NE, Baden H (1995) Pancreaticoduodenectomy for periampullary cancer. Ugeskr Laeger 157:5544–5548.
Shirai Y, Tsukada K, Ohtani T, Hatakeyama K Carcinoma of the ampulla of Vater: is radical lymphadenectomy beneficial to patients with nodal disease? J Surg Oncol 61:190–194.
Roder JD, Schneider PM, Stein HJ, Siewert JR (1995) Number of lymph node metastases is significantly associated with survival in patients with radically resected carcinoma of the ampulla of Vater. Br J Surg 82:1693–1696.
Nakao A, Harada A, Nonami T, Kaneko T, Takagi H (1996) Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 12:357–361.
Matsuda M, Nimura Y (1983) Perineural invasion of pancreas head carcinoma. Nippon Geka Gakkai Zasshi 84:719–728.
Lygidakis NJ, Stringaris K (1996) Adjuvant therapy following pancreatic resection for pancreatic duct carcinoma: a prospective randomized study. Hepatogastroenterology 43:671–680.
Gansauge F, Link KH, Rilinger N, Kunz R, Beger HG (1996) Adjuvant regional chemotherapy in advanced pancreatic cancer. Chirurgie 67:362–365.
Ohigashi H, Ishikawa O, Imaoka S et al. (1996) A new method of intraarterial regional chemotherapy with more selective drug delivery for locally advanced pancreatic cancer. Hepatogastroenterology 43:338–345.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1999 Springer-Verlag London Limited
About this chapter
Cite this chapter
Zirngibl, H. et al. (1999). Results of Radical Lymphadenectomy in Pancreatic Carcinoma. In: Johnson, C.D., Imrie, C.W. (eds) Pancreatic Disease. Springer, London. https://doi.org/10.1007/978-1-4471-0801-6_37
Download citation
DOI: https://doi.org/10.1007/978-1-4471-0801-6_37
Publisher Name: Springer, London
Print ISBN: 978-1-4471-1205-1
Online ISBN: 978-1-4471-0801-6
eBook Packages: Springer Book Archive