Standard Forms of Pancreatic Resection

  • Peter W. T. Pisters
  • Jeffrey E. Lee
  • Douglas B. Evans


As experience has increased in surgical referral centers, the published morbidity and mortality rates for pancreaticoduodenectomy have declined. Surgeons have focused on how to perform the operation safely, but less attention has been given to which patients are the most suitable candidates for pancreatectomy, or to such fundamental oncologic issues as the definition and status of microscopic surgical margins, the anatomic distribution of regional lymph node metastases, and patterns of tumor recurrence and their implications for site-specific therapeutic intervention. In contrast to surgery for adenocarcinoma of the esophagus, stomach, or colorectum, pancreaticoduodenectomy requires complete reconstruction of the upper gastrointestinal tract, including reanastomosis of the pancreas, bile duct, and stomach. The magnitude of the operation and its associated morbidity often result in a lengthy period of recovery. For patients who experience early tumor recurrence, quality survival time may be quite brief, because the time of surgical recovery merges with the time of symptomatic tumor recurrence.


Pancreatic Cancer Superior Mesenteric Artery Pancreatic Head Superior Mesenteric Vein Venous Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fuhrman GM, Charnsangavej C, Abbruzzese JL, Cleary KR, Martin RG, Fenoglio CJ, et al. Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 1994; 167; 104–111.PubMedCrossRefGoogle Scholar
  2. 2.
    Freeny PC, Traverso LW, and Ryan JA. Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 1993; 165:600–606.PubMedCrossRefGoogle Scholar
  3. 3.
    Warshaw AL, Gu ZY, Wittenberg J, and Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990; 125:230–233.PubMedCrossRefGoogle Scholar
  4. 4.
    Fernandez-del-Castillo C, Rattner DW, and Warshaw AL. Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg 1995; 82:1127–1129.PubMedCrossRefGoogle Scholar
  5. 5.
    Cuschieri A. Laparoscopy for pancreatic cancer: does it benefit the patient? Eur J Surg Oncol 1988; 14:41–44.PubMedGoogle Scholar
  6. 6.
    Bemelman WA, de Wit LT, van Delden OM, Smits NJ, Obertop H, Rauws EJ, et al. Diagnostic laparoscopy combined with laparoscopic ultrasonography in staging of cancer of the pancreatic head region. Br J Surg 1995; 82:820–824.PubMedCrossRefGoogle Scholar
  7. 7.
    Conlon KC, Dougherty E, Klimstra DS, Coit DG, Turnbull AD, and Brennan MF. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy. Ann Surg 1996; 223:134–140.PubMedCrossRefGoogle Scholar
  8. 8.
    Tyler DS and Evans DB. Reoperative pancreaticoduodenectomy. Ann Surg 1994; 219:211–221.PubMedCrossRefGoogle Scholar
  9. 9.
    Fortner JG, Kim DK, Cubilla A, Turnbull A, Pahnke LD, and Shils ME. Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection. Ann Surg 1977; 186:42–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Nagakawa T, Konishi I, Ueno K, Ohta T, Akiyama T, Kayahara M, et al. Surgical treatment of pancreatic cancer. The Japanese experience. Int J Pancreatol 1991; 9:135–143.Google Scholar
  11. 11.
    Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 1989; 124:127–132.PubMedCrossRefGoogle Scholar
  12. 12.
    Dresler CM, Fortner JG, McDermott K, and Bajorunas DR. Metabolic consequences of (regional) total pancreatectomy. Ann Surg 1991; 214:131–140.PubMedCrossRefGoogle Scholar
  13. 13.
    Hiraoka T. Extended radical resection of cancer of the pancreas with intraoperative radiotherapy. Baillieres Clin Gastroenterol 1990; 4:985–993.PubMedCrossRefGoogle Scholar
  14. 14.
    Nagakawa T, Konishi I, Ueno K, Ohta T, Akiyama T, Kanno M, et al. The results and problems of extensive radical surgery for carcinoma of the head of the pancreas. Jpn J Surg 1991; 21:262–267.PubMedCrossRefGoogle Scholar
  15. 15.
    Nagakawa T, Kurachi M, Konishi K, and Miyazaki I. Translateral retroperitoneal approach in radical surgery for pancreatic carcinoma. Jpn J Surg 1982; 12:229–233.PubMedCrossRefGoogle Scholar
  16. 16.
    Cubilla AL, Fortner J, and Fitzgerald PJ. Lymph node involvement in carcinoma of the head of the pancreas area. Cancer 1978; 41:880–887.PubMedCrossRefGoogle Scholar
  17. 17.
    Staley CA, Lee JE, Cleary KR, Abbruzzese JL, Fenoglio CJ, Rich TA, et al. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head. Am J Surg 1996; 171:118–124.PubMedCrossRefGoogle Scholar
  18. 18.
    Kayahara M, Nagakawa T, Kobayashi H, Mori K, Nakano T, Kadoya N, et al. Lymphatic flow in carcinoma of the head of the pancreas. Cancer 1992; 70:2061–2066.PubMedCrossRefGoogle Scholar
  19. 19.
    Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, and Miyazaki I. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 1994; 75:1155–1162.CrossRefGoogle Scholar
  20. 20.
    Evans DB, Lee JE, Pisters PWT. Pancreaticoduodenectomy (Whipple Operation) and total pancreatectomy for cancer. In: Nyhus LM, Baker RJ and Fischer JF (eds), Mastery of surgery, Little Brown, Boston, MA, 1997; pp. 1233–1249.Google Scholar
  21. 21.
    Tepper J, Nardi G, and Sutt H. Carcinoma of the pancreas: review of MGH experience from 1963 to 1973. Analysis of surgical failure and implications for radiation therapy. Cancer 1976; 37:1519–1524.Google Scholar
  22. 22.
    Trede M, Schwall G, and Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990; 211:447–458.PubMedCrossRefGoogle Scholar
  23. 23.
    Whittington R, Bryer MP, Haller DG, Solin LJ, and Rosato EF. Adjuvant therapy of resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys 1991; 21:1137–1143.PubMedCrossRefGoogle Scholar
  24. 24.
    Willett CG, Lewandrowski K, Warshaw AL, Efird J, and Compton CC. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993; 217:144–148.Google Scholar
  25. 25.
    Nitecki SS, Sarr MG, Colby TV, and van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancreas Is it really improving? Ann Surg 1995; 221:59–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 1995; 221:721–731.CrossRefGoogle Scholar
  27. 27.
    Allema JH, Reinders ME, van Gulik TM, Van Leeuwen DJ, de Wit LT, Verbeek PC, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. Br J Surg 1994; 81:1642–1646.PubMedCrossRefGoogle Scholar
  28. 28.
    Roder JD, Stein HJ, and Siewert JR. Carcinoma of the periampullary region: who benefits from portal vein resection? Am J Surg 1996; 171:170–175.PubMedCrossRefGoogle Scholar
  29. 29.
    Harrison LE, Klimstra DS, and Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication to resection? Ann Surg 1996; 224:342–349.PubMedCrossRefGoogle Scholar
  30. 30.
    Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ, Pisters PWT, and Evans DB. Patient survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence adenocarcinoma of the pancreatic head. Br J Surg, in press.Google Scholar
  31. 31.
    Takahashi S, Ogata Y, and Tsuzuki T. Combined resection of the pancreas and portal vein for pancreatic cancer. Br J Surg 1994; 81:1190–1193.PubMedCrossRefGoogle Scholar
  32. 32.
    Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, et al. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Ann Surg 1996; 223:154–162.PubMedCrossRefGoogle Scholar
  33. 33.
    Cusack JC, Jr., Fuhrman GM, Lee JE, and Evans DB. Managing unsuspected tumor invasion of the superior mesenteric-portal venous confluence during pancreaticoduodenectomy. Am J Surg 1994; 168:352–354.PubMedCrossRefGoogle Scholar
  34. 34.
    Traverso LW and Longmire WP, Jr. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 1978; 146:959–962.PubMedGoogle Scholar
  35. 35.
    Tsao JI, Rossi RL, and Lowell JA. Pylorus-preserving pancreaticoduodenectomy. Is it an adequate cancer operation? Arch Surg 1994; 129:405–412.Google Scholar
  36. 36.
    Grace PA, Pitt HA, and Longmire WP. Pylorus preserving pancreaticoduodenectomy: an overview. Br J Surg 1990; 77:968–974.PubMedCrossRefGoogle Scholar
  37. 37.
    Crucitti F, Doglietto G, Bellantone R, Miggiano GA, Frontera D, Ferrante AM, et al. Digestive and nutritional consequences of pancreatic resections. The classical vs the pylorussparing procedure. Int J Pancreatol 1995; 17:37–45.Google Scholar
  38. 38.
    Kozuschek W, Reith HB, Waleczek H, Haarmann W, Edelmann M, and Sonntag D. A comparison of long term results of the standard whipple procedure and the pylorus preserving pancreaticoduodenectomy. J Am Coll Surg 1994; 178:443–453.Google Scholar
  39. 39.
    Roder JD, Stein HJ, Huttl W, and Siewert JR. Pylorus-preserving versus standard pancreaticoduodenectomy: an analysis of 110 pancreatic and periampullary carcinomas. Br J Surg 1992; 79:152–155.PubMedCrossRefGoogle Scholar
  40. 40.
    Sharp KW, Ross CB, Halter SA, Morrison JG, Richards WO, Williams LF, et al. Pancreatoduodenectomy with pyloric preservation for carcinoma of the pancreas: a cautionary note. Surgery 1989; 105:645–653.PubMedGoogle Scholar
  41. 41.
    Patel AG, Toyama MT, Kusske AM, Alexander P, Ashley SW, and Reber HA. Pyloruspreserving Whipple resection for pancreatic cancer. Is it any better? Arch Surg 1995; 130:838–842.CrossRefGoogle Scholar
  42. 42.
    Cameron JL, Crist DW, Sitzmann JV, Hruban RH, Boitnott JK, Seidler AJ, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 1991; 161:120–124.PubMedCrossRefGoogle Scholar
  43. 43.
    Bakkevold KE and Kambestad B. Long-term survival following radical and palliative treatment of patients with carcinoma of the pancreas and papilla of Vater—the prognostic factors influencing the long-term results. A prospective multicentre study. Eur J Surg Oncol 1993; 19:147–161.Google Scholar
  44. 44.
    Geer RJ, and Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993; 165:68–72.PubMedCrossRefGoogle Scholar
  45. 45.
    Zerbi A, Fossati V, Parolini D, Carlucci M, Balzano G, Bordogna G, et al. Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer. Cancer 1994; 73:2930–2935.PubMedCrossRefGoogle Scholar
  46. 46.
    Allema JH, Reinders ME, van Gulik TM, Koelemay MJ, Van Leeuwen DJ, de Wit LT, et al. Prognostic factors for survival after pancreaticoduodenectomy for patients with carcinoma of the pancreatic head region. Cancer 1995; 75:2069–2076.PubMedCrossRefGoogle Scholar
  47. 47.
    Kaiser MH and Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985; 120:899–903.Google Scholar
  48. 48.
    Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987; 59:2006–2010.Google Scholar
  49. 49.
    Foo ML, Gunderson LL, Nagorney DM, McLlrath DC, van Heerden JA, Robinow JS, et al. Patterns of failure in grossly resected pancreatic ductal adenocarcinoma treated with adjuvant irradiation +/−5 fluorouracil. Int J Radiat Oncol Biol Phys 1993; 26:483–489.PubMedCrossRefGoogle Scholar
  50. 50.
    Hoffman JP, Weese JL, Solin LJ, et al. Preoperative chemoradiation for patients with resectable pancreatic adenocarcinoma: an Eastern Cooperative Oncology Group (ECOG) phase II study. Proc Am Soc Clin Oncol 1995; 14:201.Google Scholar
  51. 51.
    Spitz FR, Abbruzzese JL, Lee JE, Pisters PWT, Lowy AM, Fenoglio CJ, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997; 15:928-937.Google Scholar
  52. 52.
    Evans DB, Abbruzzese JL, and Rich RA. Cancer of the pancreas. In: DeVita VT Jr, Hellman S, and Rosenberg SA (eds), Cancer: principles and practice of oncology, 5th ed., Lippincott, Philadelphia, PA, 1997; pp. 1054–1087.Google Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Peter W. T. Pisters
  • Jeffrey E. Lee
  • Douglas B. Evans

There are no affiliations available

Personalised recommendations