[Extended resection of pancreatic and periampullar carcinoma: regional, total and partial duodenopancreatectomy (author's transl)].

The prognosis of exocrine carcinoma of the pancreas is still quite bad; because of that, total duodenopancreatectomy following the procedure by Fortner has been our surgical approach since January 1978. Since that time surgery of periampullary carcinoma was extended as well in such a way, that first and second order lymph nodes were excised systematically. Following the introduction of these procedures the percentage of patients with exocrine pancreatic carcinoma operated upon rose from 12 to 35%, - the percentage of patients operated upon because of periampullary carcinoma correspondingly rose from 61 to 91% of all patients carrying these tumors. The incidence of lymphogenous metastases was 88% in 17 patients, which had surgery because of ductal pancreatic carcinoma, and 27% in 22 patients with periampullary carcinoma. 29% of patients with pT1-3 tumors and 71% of patients with pT4 tumors did have already lymphogenous metastases. In 22% of the cases, who would have been operated upon by conventional total duodenopancreatectomy metastases were found in the second order lymph nodes which were taken out according to the new more radical surgical approach; the corresponding figure for patients, who were operated upon by partial duodenopancreatectomy was 5%. Mortality of regional partial duodenopancreatectomy was 4% in our series, and mortality after regional total duodenopancreatectomy was similar to that of conventional pancreatectomy without dissection of lymph nodes.