Locoregional dissemination and extended lymphadenectomy in pancreatic cancer

Carcinoma of the pancreas is characterized by the high frequency of intrapancreatic (from 75 to 100%) and extrapancreatic neural invasion (from 64 to 69%). Even small-sized tumors (T-1) show plexus invasion. Carcinoma of the pancreas is also associated with a high incidence (76%) of lymph node metastasis. The knowledge of local and regional tumor spread is mandatory in the planning of rational surgical treatment with the intention to cure. At present, it does not seem possible to predict the direction of lymph drainage leading to nodal involvement in different anatomical areas. However, the anterior and posterior pancreaticoduodenal areas are generally involved at first and nodes farther away from the primary tumor mostly show metastases only after involvement of the nearer nodes. We believe, radical pancreatoduodenectomy should be based on three aspects: wide lymph node dissection; radical retroperitoneal dissection, and pancreatectomy with an extirpation line left of the coeliac axis for tumors of the head and left pancreatectomy for tumors of the body and tail of the pancreas. Conclusions: Cure or long-term palliation of pancreatic cancer is generally possible only after complete erradication of the primary tumor, including its local and regional extensions.