How I Do It
Extended Radical Whipple Resection for Cancer of the Pancreatic Head: Operative Procedure and ResultsImaizumi T. · Hanyu F. · Harada N. · Hatori T. · Fukuda A.
Department of Gastroenterological Surgery, Tokyo Women’s Medical College, Tokyo, Japan
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Pancreatoduodenectomy is now the most fundamental operation for cancer of the pancreatic head. However, with the conventional operative procedure, the resection rate is low and long-term results are extremely poor. We introduced an extended radical Whipple operation in 1978 to improve surgical curability. Systemic dissection of extended lymph nodes and plexuses and en bloc resection of the portal vein was the basic concept. The resection rate for cancer of the pancreatic head has improved from 7–20 to 50%. The curative resection rate has also improved from 10 to 40–50%. The extended procedure did not increase the risk of the Whipple operation. When curative surgery was performed, good long-term survival was expected even in cases of extensive invasion to the portal vein. As a result, 11 patients who underwent curative surgery have survived for a long period of time. At present, however, the majority of patients are in an advanced stage at diagnosis and extended radical operation plays an important role in the curative therapy for this condition.
Gudjonsson B: Cancer of the pancreas, 50 years of surgery. Cancer 1987;50:2284–2303.
- Nitecki SS, Sarr MG, Colby TV, van Deerden JA: Long-term survival after resection for ductal adenocarcinoma of the pancreas. Ann Surg 1995;221:59–66.
- Wade TP, El-Ghazzawy AG, Virgo KS, Johnson FE: The Whipple resection for cancer in U.S. Department of Veterane Affairs Hospitals. Ann Surg 1995;221:241–246.
- Grace PA, Pitt HA, Tompkins RK, DenBeaten L, Longmire WP Jr: Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg 1986;151:141–149.
Andersen HB, Baden H, Brahe NEB, Burcharth F: Pancreaticoduodenectomy for periampullars adenocarcinoma. J Am Cell Surg 1994;179:545–552.
- Allema JH, Reinders ME, van Gulik TM, Koelemay MJ, van Leewen DJ, de Wit LT, Gouma DJ, Obertop H: Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer 1995;75:2069–2076.
Criat DW, Sitsmann JV, Cameron JL: Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg 1987;205:358–365.
- Fernandez-del Gastillo F, Rattner DW, Warshaw AL: Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295–300.
- Trade M, Schwall G, Saeger H: Survival after pancreatoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg 1990;211:447–458.
The Pancreatic Cancer Registry of the Japan Pancreas Society: Annual report of registered cases of pancreatic cancer in Japan (in Japanese), 1993.
- Fortner JG: Regional resection of cancer of the pancreas, a new surgical approach. Surgery 1973;73:307–320.
Hanyu F, Suzuki M, Imaizumi T: Whipple operation for pancreatic carcinoma – Japanese experience; in Beger HG, Büchler MW, Malfertheiner P (eds): Standards in Pancreatic Surgery. Berlin, Springer, 1993, pp 646–653.
The Japan Pancreas Society: General rules for cancer of the pancreas (in Japanese). Tokyo, Kanchare Shuppan, 1986.
- Traverso LW, Longmire WP: Presentation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978;146:959–962.
TNM Atlas: Berlin, Springer, 1992, pp 132–139.
Whipple AO, Parsons WB, Mullins CR: Treatment of carcinoma of the ampulla of Vater. Ann Surg 1935;102:763–779.
Cattell RB: Resection of the pancreas: Dissection of special problem. Surg Clin North Am 1943;23:753–766.
Child CGM: Pancreaticojejunectomy and other problems associated with pancreas. Ann Surg 1994;119:845–855.
Moore GE, Sako Y, Thomas LB: Medical pancreaticoduodenectomy with resection and reanastomosis of the superior mesenteric vein. Surgery 1951;30:1–4.
McDermott WV Jr: A one-stage pancreatoduodenectomy with resection of the portal vein for carcinoma of the pancreas. Ann Surg 1952;136:1012–1017.
- Nagakawa T, Kurachi M, Konishi K: Translateral retroperitoneal approach in radical surgery for pancreatic carcinoma. Jpn J Surg 1982;12:229–233.
Hanyu F, Imaizumi T: Extended radical surgery for carcinoma of the head of the pancreas; in Beger HG, Büchler MW, Schoenberg MH (eds): Cancer of the Pancreas. Ulm, Universitätsverlag Ulm, 1996, pp 389–395.
Porter RA: Carcinoma of the pancreaticoduodenal area, operability and choice of procedure. Ann Surg 1958;148:711.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.