TY - JOUR
T1 - Pancreatic resection for ductal adenocarcinoma
T2 - Total pancreatectomy versus partial pancreatectomy
AU - Farley, David R.
AU - Sarr, Michael G.
AU - van Heerden, Jon A.
PY - 1995
Y1 - 1995
N2 - The controversy regarding total versus partial pancreatectomy for ductal adenocarcinoma of the pancreatic head remains unsettled. Proponents of total pancreatectomy claim wider margins of resection, avoidance of a troublesome pancreaticoenterostomy, and removal of a potentially multicentric disease. Advocates of partial pancreatectomy highlight the retention of exocrine and endocrine pancreatic function, the maintenance of splenic function, and a lower risk of marginal ulceration without sacrificing curative potential. Analysis of the current surgical literature with focus on the facets of each procedure that may differ (operative mortality, long‐term survival, and the six factors mentioned above), may help to resolve the controversy. The data reviewed would suggest that 1) wider resection margins have not transferred into longer postoperative survival, 2) the risk of multicen‐tricity is probably low and of questionable significance, and 3) the morbidity and mortality of pancreaticoenterostomy is currently less problematic. The additional benefits of retaining pancreatic endocrine and exocrine function, maintaining splenic immune competence, and a lower risk of marginal ulceration convinces us to advocate partial pancreatectomy over total pancreatectomy for the majority of patients with a resectable ductal adenocarcinoma of the pancreatic head. © 1995 Wiley‐Liss, Inc.
AB - The controversy regarding total versus partial pancreatectomy for ductal adenocarcinoma of the pancreatic head remains unsettled. Proponents of total pancreatectomy claim wider margins of resection, avoidance of a troublesome pancreaticoenterostomy, and removal of a potentially multicentric disease. Advocates of partial pancreatectomy highlight the retention of exocrine and endocrine pancreatic function, the maintenance of splenic function, and a lower risk of marginal ulceration without sacrificing curative potential. Analysis of the current surgical literature with focus on the facets of each procedure that may differ (operative mortality, long‐term survival, and the six factors mentioned above), may help to resolve the controversy. The data reviewed would suggest that 1) wider resection margins have not transferred into longer postoperative survival, 2) the risk of multicen‐tricity is probably low and of questionable significance, and 3) the morbidity and mortality of pancreaticoenterostomy is currently less problematic. The additional benefits of retaining pancreatic endocrine and exocrine function, maintaining splenic immune competence, and a lower risk of marginal ulceration convinces us to advocate partial pancreatectomy over total pancreatectomy for the majority of patients with a resectable ductal adenocarcinoma of the pancreatic head. © 1995 Wiley‐Liss, Inc.
KW - ductal adenocarcinoma
KW - pancreatic head
KW - partial pancreatectomy
KW - total pancreatectomy
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U2 - 10.1002/ssu.2980110209
DO - 10.1002/ssu.2980110209
M3 - Article
AN - SCOPUS:0028928280
SN - 8756-0437
VL - 11
SP - 124
EP - 131
JO - Seminars in Surgical Oncology
JF - Seminars in Surgical Oncology
IS - 2
ER -