Journal
LANGENBECKS ARCHIVES OF SURGERY
Volume 397, Issue 6, Pages 927-932Publisher
SPRINGER
DOI: 10.1007/s00423-012-0934-8
Keywords
Local recurrence; Extended pancreatectomy; Intraoperative radiation therapy; Pancreatic cancer; Autopsy study
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Funding
- Grants-in-Aid for Scientific Research [23591898] Funding Source: KAKEN
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Local relapses frequently occur even after curative resection of pancreatic cancer. To control local recurrence, we adopted extended radical resection combined with intraoperative radiation therapy. A retrospective review was conducted on 41 patients who underwent extended radical pancreatectomy combined with intraoperative radiation therapy for pancreatic cancer. Fourteen patients underwent autopsies. We took en bloc specimens of the abdominal aorta with surrounding connective tissue to evaluate histological characteristics of local status at autopsies. Autopsies disclosed microscopic local recurrence in five (36%) of the 14 patients, although no evidence of local relapse was observed in either follow-up images or macroscopic findings at autopsy. Of the three patients with R1 resection, two had no local recurrence microscopically at autopsy. Histological features of local recurrence in autopsy samples showed small numbers of cancer cells surrounded by thick connective tissue without mass formation. The autopsy study revealed that a characteristic of local recurrence after this treatment was tiny cancer cells scattered in dense connective tissue; these cells were undetected by follow-up imaging.
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