Extended Radical Whipple Resection for Cancer of the Head of the Pancreas

Abstract

Despite advances in diagnostic procedures, early detection of pancreatic cancer is still rare in most cases. Therefore, surgical therapy is often performed in advanced cases of invasive ductal adenocarcinoma of the pancreas, and the long-term prognosis is poor. The 5-yr survival rate of pancreatic cancer is reported to be 3.5–25% in Western countries (1–9). The 1993 annual report of registered cases of pancreatic cancer in Japan (10) showed that the 5-yr survival rate was 17.5% after curative surgery, which is much lower than that in other cancers of the gastrointestinal tract. In the early years of the authors’ department, a standard operation was performed only to remove the main tumor; therefore, the resection rate was low and surgical treatment was often noncurative. Reflecting on the poor results, and inspired by Fortner’s report on regional pancreatectomy (11), this department introduced the extended radical Whipple resection in 1978 (12). Depending on the extent of cancer invasion, major vessels including the portal vein, lymph nodes, and nerve plexuses were resected en bloc in order to improve the radicality of surgery. There are now 11 5-yr survivors after trial and error. This paper reports on this operative procedure for invasive ductal adenocarcinoma of the pancreatic head, and the postoperative results achieved in this department.