Carcinoma of the head of the pancreas: review of 67 cases and comparison with 27 additional periampullary carcinomas.
OBJECTIVE
Carcinoma of the head of the pancreas is reported with increasing incidence. The classical Whipple procedure, modified by Traverso and Longmire, is a major surgical undertaking and there is question on its indication in the case of lesions which, although technically resectable, are not susceptible to cure.


METHODS
We review 67 cases of carcinoma of the head of the pancreas comparing the results of radical vs. palliative surgery. The results were then compared with 27 additional cases of periampullary carcinomas.


RESULTS
Long term survival was obviously higher after resection, due to the more advanced tumor stage in the palliation group. However, perioperative mortality, supposedly high in extensive resective surgery, was 8.7% (vs 11.9% in the palliation group).


CONCLUSIONS
At present, extensive resective surgery carries unacceptable incidence of perioperative mortality. Therefore we suggest that indication for resection should be widened, as it may offer better chances of cure in resectable periampullary carcinomas and, even in non curable cases, it offers better quality of life and the advantages of tumor debulking.
Taschieri
A M
AM
Chirurgia Generale II, Universita degli Studi di Milano Ospedale L.Sacco, Italy.
Elli
M
M
Rovati
M
M
Porretta
T
T
Montecamozzo
G
G
Gerlinzani
S
S
Cristaldi
M
M
D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery*; D014670:Ampulla of Vater; D016022:Case-Control Studies; D003138:Common Bile Duct Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors