Pancreaticoduodenectomy for locally advanced gastric cancer

Background/Aims: This study was conducted to evaluate the therapeutic efficacy of pancreaticoduodenectomy (PD) in the patients with locally advanced gastric cancer. Methodology: 25 gastric cancer patients who underwent PD with gastrectomy were analyzed. The indications of PD were 1) suspicion of direct invasion to the pancreas head (n = 15), 2) invasion to duodenal second portion (n = 6), 3) both pancreatic and duodenal invasion (n = 3), and 4) conglomerated lymph node enlargement around the pancreas head (n = 1). Results: Mean operation time was 349.5 (+/- 86.5) minutes and mean amount of RBC transfusion was 3.4 (+/- 2.1) pints. Postoperative complications were encountered in 8 patients (32%, but re-operation was required only in 2 cases. No postoperative 30-day mortality occurred after PD. Overall the median survival was 16.5 months with a 5-year survival rate of 15.8%. Two patients with T2bN0M0 and T2bN1M0 stages were still alive for 11.5 years and 5.7 years without any evidence of cancer recurrence. Conclusions: Considering the acceptable postoperative morbidity rate and the long-term survivors in selected cases, PD could be considered as one of the therapeutic options for locally advanced gastric cancer.