Analysis of Pancreatoduodenectomy
AbstractAbstract: Thirty-three pancreaticoduodenectomies were performed at the Medical University of South Carolina between 1956 and 1970. Seventeen resections were for adenocarcinoma of the head of the pancreas. Eleven Whipple procedures were performed for cancer arising in the extrahepatic biliary ducts and duodenum. Cancer of the stomach accounted for three pancreaticoduodenectomies. The remaining two procedures were for cystadenocarcinoma of the pancreas and chronic pancreatitis. Twelve resections were performed on clinical evidence alone. Carcinoma was found in every specimen. Biopsy and frozen section were used in the other 21 resections. Resection was undertaken only when there was no gross evidence of lymph node metastases. Still, the pathologic analyses of the specimen revealed nodal metastases in 39% of the pancreatic carcinomas. None of these patients with positive nodes were long-term survivors. There were 14 major complications from the 33 pancreaticoduodenectomies. Failure of the pancreaticojejunostomy was the most frequent complication. Seven patients were operative mortalities. In each surgical mortality, the preoperative bilirubin was markedly elevated. At this writing, eight patients (25%) are alive and free of disease. Carcinoma of the ampulla of Voter had the best survival rate. The worst survival rate was found in carcinoma of the duodenum and carcinoma of the common bile duct. The history and current controversies over this extensive surgical resection are reviewed.
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