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D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer.

BACKGROUND/AIMS
The aim of this study was to evaluate the influence of standard pancreatoduodenectomy versus pancreatoduodenectomy with extended lymphadenectomy and the role of adjuvant therapy on survival in patients with ductal adenocarcinoma of the pancreatic head. In addition the problems related to resection are discussed.


METHODOLOGY
A total number of 124 pts operated on between 1985 and 1999 were divided into three groups according to our different strategies. Standard resection (D1) was performed on 48 patients (group A), extended resection (D2) on 45 patients (group B) and combined treatment (extended resection plus adjuvant therapy) on 31 patients. The outcome of these three groups was compared with regard to postoperative morbidity and survival.


RESULTS
There was no significant difference in terms of survival between group A and B, while adjuvant therapy (group C), achieved statistical significance as factor influencing survival, together with tumor stage.


CONCLUSIONS
Our data suggest that no further improvement can be obtained on long-term survival by extended retroperitoneal dissection while chemoradiotherapy showed a doubling of median survival.