Rational Dissection of Lymphatic and Nervous Tissue in Curative Resection for Pancreatic Cancer

Rational dissection of lymphatic and nervous tissue in curative resection for pancreatic cancer was studied on 46 patients with extended operation, containing 35 patients with IORT and 15 patients with ts1 tumor. Lymph node involvement and extrapancreatic nerve plexus invasion were found in 80% and 66.7% of patients with extended operation, respectively. Curative resection rate of these cases was 71%. Five year survival rates of 35 patients with IORT and patients with stage IVa tumor were 16.8% and 18.9%, respectively. Patients with stage IVb tumor or n2 lymph node involvement died within one year. At autopsy, control of local recurrence was improved in patients with IORT. Patients with small tumor within 1cm in diameter had good prognosis by standard operation. For tumor within 1cm, standard operation may be indicated. Extended operation with IORT should be performed for tumor over 1cm to stage IVa tumor and should not be done for tumor of stage IVb or with n2 lymph node involvement.