Langenbeck's Archives of Surgery

, Volume 393, Issue 2, pp 157–162 | Cite as

Survival benefits of pancreatoduodenectomy for gastric cancer: relationship to the number of lymph node metastases

  • Souya Nunobe
  • Naoki Hiki
  • Shigekazu Ohyama
  • Tetsu Fukunaga
  • Yasuyuki Seto
  • Toshiharu Yamaguchi
Original Article


Background and aims

Pancreatoduodenectomy (PD) for advanced gastric cancer is rarely performed because of the high frequency of associated morbidity and mortality. The aim of this study was to determine the limited indication of PD for advanced gastric cancer.

Materials and methods

From January 1984 and December 2005 patient’s charts were reviewed and outcomes after PD for gastric cancer were compared between two subgroups; those with a ‘high’ number (7≤ group) of lymph node metastases and those with ‘low’ numbers (6≥ group).


PD was intraoperatively selected because of direct tumor invasion into the pancreas (52.2% of the 7≤ group vs 12.5% of the 6≥ group) or pancreatic lymph node infiltration (47.8% of the 7≤ group vs 87.5% of the 6≥ group; P = 0.058). The postoperative histological analysis showed 22 cases from 23 (95.7%) in 7≤ group with T3 or T4 tumor, compared with only 4 cases (50%) in 6≥ group (P = 0.014). The 5-year survival rates were significantly better in the 6≥ group compared with the 7≤ group (P = 0.014).


The indication for PD in advanced gastric cancer should consider the degree of extensive lymph node metastases and incurable factors.


Gastric cancer Pancreatoduodenectomy Lymph node metastasis 


  1. 1.
    Maehara Y, Okuyama T, Moriguchi S, Orita H, Kusumoto H, Korenaga D, Sugimachi K (1992) Prophylactic lymph node dissection in patients with advanced gastric cancer promotes increased survival time. Cancer 70:392–395PubMedCrossRefGoogle Scholar
  2. 2.
    Maehara Y, Sugimachi K, Akagi M, Kakegawa T, Shimazu H, Tomita M (1992) Early postoperative chemotherapy following noncurative resection for patients with advanced gastric cancer. Br J Cancer 65:413–416PubMedGoogle Scholar
  3. 3.
    Maehara Y, Okuyama T, Oshiro T, Baba H, Anai H, Akazawa K, Sugimachi K (1993) Early carcinoma of the stomach. Surg Gynecol Obstet 177:593–597PubMedGoogle Scholar
  4. 4.
    Korenaga D, Tsujitani S, Haraguchi M, Okamura T, Tamada R, Sugimachi K, Akazawa K, Nose Y (1988) Long-term survival in Japanese patients with far advanced carcinoma of the stomach. World J Surg 12:236–240PubMedCrossRefGoogle Scholar
  5. 5.
    Ohashi (1985) Combined resection of adjacent organs for advanced cancer of the stomach: pancreatoduodenectomy and left upper evisceration. Surg Ther 52:173–180Google Scholar
  6. 6.
    Shchepotin IB, Chorny VA, Nauta RJ, Shabahang M, Buras RR, Evans SR (1998) Extended surgical resection in T4 gastric cancer. Am J Surg 175:123–126PubMedCrossRefGoogle Scholar
  7. 7.
    Siewert JR, Bottcher K, Stein HJ, Roder JD (1998) Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 228:449–461PubMedCrossRefGoogle Scholar
  8. 8.
    Sobin LH, Fleming ID (1997) TNM classification of malignant tumors, 5th edn. (1997) Union Internationale Contre le Cancer and the American Joint Committee on Cancer. Cancer 80:1803–1804PubMedCrossRefGoogle Scholar
  9. 9.
    Katai H, Yoshimura K, Maruyama K, Sasako M, Sano T (2000) Evaluation of the new international union against cancer TNM staging for gastric carcinoma. Cancer 88:1796–1800PubMedCrossRefGoogle Scholar
  10. 10.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma, 2nd English Edition. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  11. 11.
    Isozaki H, Okajima K, Kawashima Y, Yamada S, Nakajima T, Nakata E, Nishimura J, Yoshioka T, Ichinona T, Asaka K (1991) Gastric cancer infiltrating to other organs. J Jpn Soc Clin Surg 52:2573–2578Google Scholar
  12. 12.
    Maehara Y, Oshiro T, Baba H, Ohno S, Kohnoe S, Sugimachi K (1995) Lymphatic invasion and potential for tumor growth and metastasis in patients with gastric cancer. Surgery 117:380–385PubMedCrossRefGoogle Scholar
  13. 13.
    Korenaga D, Okamura T, Baba H, Saito A, Sugimachi K (1988) Results of resection of gastric cancer extending to adjacent organs. Br J Surg 75:12–15PubMedCrossRefGoogle Scholar
  14. 14.
    Ajisaka H, Fujita H, Kaji M, Maeda K, Yabushita K, Konishi K, Uchiyama A, Miwa A (2001) Treatment of patients with gastric cancer and duodenal invasion. Int Surg 86:9–13PubMedGoogle Scholar
  15. 15.
    Buchholtz TW, Welch CE, Malt RA (1978) Clinical correlates of resectability and survival in gastric carcinoma. Ann Surg 188:711–715PubMedCrossRefGoogle Scholar
  16. 16.
    Maehara Y, Oiwa H, Tomisaki S, Sakaguchi Y, Watanabe A, Anai H, Sugimachi K (2000) Prognosis and surgical treatment of gastric cancer invading the pancreas. Oncology 59:1–6PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Souya Nunobe
    • 1
  • Naoki Hiki
    • 1
  • Shigekazu Ohyama
    • 1
  • Tetsu Fukunaga
    • 1
  • Yasuyuki Seto
    • 1
  • Toshiharu Yamaguchi
    • 1
  1. 1.Department of SurgeryCancer Institute HospitalTokyoJapan

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