title: Curative and palliative surgical treatment of pancreaticoduodenal adenocarcinoma.
abstract: In the period 1965 to 1976 inclusive, 55 patients suffering from duodenopancreatic adenocarcinoma were surgically treated at the Free University Hospital. Twenty of these patients underwent a 'curative' Whipple pancreaticoduodenectomy for a resectable tumor. The difference in survival time makes a differentiation important between carcinomas occurring in the head of the pancreas and those of the peri-ampullary region. In our series, 11 of the former were found and 9 of the latter group. Of each group one patient died within 30 days of the operation. The average survival time of 9 patients, operated on for a tumor in the head of the pancreas, was 10.2 months, with a range from 2 to 23 months. One patient is still alive 23 months after the operation. The average survival time of 5 patients with a periampullary tumor was 22 months with a range from 6 to 52 months. Three patients are still alive, one more than 12 years and 2 more than 19 months after operation. Considering the bad results, and the fact that 30 percent of pancreatic carcinomas are multifocal, it would seem that the classical Whipple operation is a thing of the past. One can then make a plea for total pancreaticoduodenectomy or even for a regional pancreatectomy. Thirty-five patients underwent a palliative procedure, consisting of a biliary bypass combined in a number of cases with a gastroenterostomy. Five patients died within 30 days of the operation. The average survival time for the remaining patients was 9.5 months with a range of 1.5 to 30 months.
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009426:Netherlands; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies