Abstract: 【Abstract】 Objective To investigate the clinical efficacy of total pancreaticoduodenectomy for the pancrea tic head adenocarcinoma with positive neck margin.
Methods:The clinical data of 15 patients with pancreatic head adenocarcinoma and had positive neck margin who received total pancreaticoduodenectomy at the Union Hospital of Fujian Medical University from August 2009 to May 2014 were retrospectively analyzed. Patients were followed up by out patient examination or telephone interview till August 2014.
Results:Total pancreaticoduo denectomy was successfully carried out on the 15 patients. The operation time was 4.0 10.0 hours (mean, 6.5 hours), and the volume of blood loss was 300 2 000 mL (mean, 800 mL). The duration of postoperative hospital stay was 13.0 35.0 days (mean, 22.3 days). The main postoperative complications included pulmonary infection (3 cases),  abdominal infection (2 cases)and low blood glucose (2 cases). No interoperative death, bile leakage or gastrointestinal anastomotic fistula occurred. The blood glucose of most of the patients was controlled by insulin or pancreatin. No stomachache, steatorrhea or malnutrition occurred in all the patients. The mean time of postoperative follow up was 21 months (range, 3 months to 5 years). Three patients survived within 1 year, 2 survived for 1 2 years, 5 survived for more than 2 years and 1 survived for more than 5 years. Four patients with follow up time under 6 months survived till now. Five patients had liver metastasis at postoperative month 6.
Conclusion: Total pancreaticoduodenectomy might be necessary for the pancreatic head adenocarcinoma with positive neck margin to achieve R 0 resection.