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Figure 5-21 The retroperitoneal dissection component of the extended lymphadenectomy. The retroperitoneum is dissected from the hilum of the right kidney (K) to the left lateral border of the aorta (Ao) in the horizontal axis, to expose the left renal vein. In the vertical axis, the dissection extends from the level of the portal vein to below the level of the third portion of the duodenum (level of the inferior mesenteric artery [IMA] origin). Here the gastric staple line and pancreatic remnant (P) are being retracted toward the upper right. The inferior vena cava (IVC) and aorta are fully exposed, and the right gonadal vein has been preserved. A curved vascular clamp gently occludes the inferior aspect of the bile duct. The retroperitoneal fat and lymph nodes are being resected en bloc (bottomright). (From Yeo, C.J., Cameron J.L., Sohn, T.A., etal: Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: Comparison of morbidity, mortality and short-term outcome. Ann. Surg., 229:613, 1999, with permission.)

Portal v.

resected en bloc

Figure 5-22 The actuarial survival curves for all patients who survived the immediate postoperative period, comparing the standard resection (n = 53) and the radical resection (n = 56) groups. The 1- and 2-year survival rates were 77 and 47% for the standard group, respectively, compared with 83 and 56% for the radical group (P = .6, NS). (From Yeo, C.J., Cameron, J.L., Sohn, T.A., etal.: Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: Comparison of morbidity, mortality and short-term outcome. Ann. Surg., 229:613, 1999, with permission.)

Figure 5-23 Actuarial survival curves comparing patients 80 years of age or older undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 41; median survival, 32 months; 5-year survival, 19%) to those younger than 80 years (n = 454; median survival, 20 months; 5-year survival 27% P = 0.77). (From Sohn, T.A., Yeo, C.J., Cameron, J.L., et al.: Should pancreaticoduodenectomy be performed in octogenarians? J. Gastrointest. Surg., 2:207, 1998, with permission.)

Figure 5-24 Near the completion of a distal pancreatectomy and splenectomy for a tumor in the body of the pancreas. The spleen and tail of the pancreas have been mobilized out of the retro peritoneum. The pancreatic parenchyma is being divided with the electrocautery. (From Cameron, J.L.: Atlas of Surgery, vol. 1. Toronto, B.C. Decker, 1990, p. 27, with permission.)

Figure 5-25 The actuarial survival curves for patients undergoing pancreaticoduodenectomy comparing patients receiving adjuvant therapy (n = 120) to those declining adjuvant therapy (n = 53; P = .003). (From Yeo, C.J., Abrams, R.A., Grochow, L.B., et al.: Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival. A prospective, single institution experience. Ann. Surg., 225:621, 1997, with permission).


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