Noboru Noto

Follow-up Studies of Radical Resection for Pancreaticoduodenal Cancer

AbstractIn a study of 66 patients with pancreaticoduodenal cancer with pancreaticoduodenectomy, there were five (7.5%) hospital deaths. Five-year survival rates were 7.8% in 20 patients with carcinoma of the head of the pancreas, 16.7% in 31 patients with carcinoma of the bile duct, and 38.5% in 15 patients with carcinoma of the ampulla of Vater. Fecal fat loss measured was 10 g or less per day in nine of 12 patients. Of the 19 patients having glucose tolerance tests, 13 showed abnormalities including the two who were diabetic. Operative findings which were indicative of a poor prognosis included lymph node metastases, macroscopic invasion of the tumor into the pancreatic capsule in patients with carcinoma of the head of the pancreas, the size of the tumor in those with carcinoma of the common bile duct, and direct invasion of the lesion into the pancreas in patients with carcinoma of the ampulla of Vater.

Appraisal of operative treatment for chronic pancreatitis: With special reference to side to side pancreaticojejunostomy

A total of sixty-one operations were performed in sixty of seventy-one patients with chronic pancreatitis, with the following results. 1. The procedures used were side to side pancreaticojejunostomy in twenty-four patients, caudal pancreatectomy in ten, pancreaticoduodenectomy in six, total pancreatectomy in one, removal of pancreatic calculi in four, cystojejunostomy in two, biliary tract procedures in twelve, and drainage of pancreatic abscess in one. Operative fatality occurred in six patients, with fifty-four surviving operation. 2. Of fifty-three patients surviving operation (excluding the one who underwent only exploratory laparotomy), forty-seven (88 per cent) had relief of pain. With the exception of two patients with complicating cancer of the pancreas at the time of operation, of fifty-two patients surviving operation, thirty-nine (75 per cent) had satisfactory results at follow-up study. 3. Sixteen of twenty-four patients (66.7 per cent) undergoing side to side pancreaticojejunostomy had satisfactory follow-up results. 4. Comparison of pre- and postoperative body weight levels in twenty-one patients undergoing side to side pancreaticojejunostomy showed a postoperative loss of less than 10 per cent in seven, unchanged weight in two, and a gain in eleven patients, including five with more than 10 per cent gain. However, fat absorption examination in these patients showed no distinct postoperative improvement in digestion and absorption. 5. Histologic evidence in one patient at autopsy four years and eleven months after side to side pancreaticojejunostomy indicated improvement in fibrosis of the pancreas as compared with the findings at operation.

Follow-up results of surgical treatment for chronic pancreatitis. Present status in Japan.

The results of surgical treatment for chronic pancreatitis at our clinic and in the eight leading institutions of Japan were reviewed in a total of 328 cases. Abdominal pain disappeared or was alleviated in about 90 percent of the patients who survived more than 6 months after operation. There was no significant differences in the effect of pain among the three main types of operations: pancreaticoduodenectomy, distal resection and pancreatic ductal drainage. In the collected cases, however, complete disappearance of pain was reported more often in patients subjected to Puestows operation than in those who underwent Nardis operation. The patients who underwent pancreatic ductal drainage had a greater postoperative weight gain than those without drainage, in both our patients and the collected cases. In the collected cases, Puestows operation was predominantly linked to postoperative weight gain. Evidence of pancreatic functional improvement, either in endocrine or in exocrine, was very meager.

Factors influencing the late results of operation for carcinoma of the pancreas

In 151 patients with carcinoma of the pancreas presenting at the surgical clinic of Tohoku University Hospital, predominant factors affecting postoperative prognosis were studied with relation to the stages of the disease. The presence of lymph node metastasis and of cancer invasion to the pancreatic capsule, particularly the latter, was apparently a significant factor most crucially affecting the survival of the patients who underwent pancreatoduodenectomy. The mean survival periods of resected patients were 16.4 months for those with carcinoma of the head of the pancreas and 11.0 months for those with carcinoma of the body and tail of the pancreas, distinctly longer than after palliative operations. However, in patients with stage III disease, pancreatoduodenectomy tended to lead to a shorter period of survival, suggesting that surgery at that stage is generally unpromising for cure.