Isolated pancreatectomy for ductal carcinoma of the head of the pancreas.

Hepatic carcinoma recurrence in the early months after pancreatectomy for ductal carcinoma of the head of the pancreas is one of the major factors of the poor survival rate. Early hepatic recurrence might be caused by carcinoma cells entering the portal vein as a result of surgical manipulations. To deal with this problem, we devised a new operative procedure called "isolated pancreatectomy" in 1987. This method involves no-touch pancreatic resection combined with extensive retroperitoneal skeletonization. Both the feeding and draining vessels of the pancreatic carcinoma are ligated and divided prior to pancreatectomy. The confluence of the portal vein, the superior mesenteric vein, and the splenic vein is removed together with the pancreatic head. The wide surgical field thus obtained facilitates subsequent skeletonization of the retroperitoneum. We have experienced 71 cases of pancreatectomy for ductal carcinoma of the head of the pancreas among whom isolated pancreatectomy has been performed in 16 patients since 1987. In all cases, long-term survival was obtained in the patients undergoing curative and extended resection. The cumulative five-year survival rate for stages I and II was 40.7%, and that for stage III was 17.3%. After the introduction of isolated pancreatectomy, hepatic recurrence rates within six months and 12 months after pancreatectomy have dropped to 0% and 16.7%, respectively, from the 22.9% and 31.3% of the other pancreatectomy. The survival rate for the patients with stage III in isolated pancreatectomy significantly exceeded that obtained with other pancreatectomy.