[Second-look operation in pancreatic carcinoma previously assessed as unresectable].
BACKGROUND
The only curative therapy for patients with pancreatic carcinoma consists of -complete surgical tumour removal. Preoperative diagnostic investigations may help, however, the definite decision on tumour resectability can only be made intraoperatively during explorative laparotomy.


METHODS
We report herein on 17 patients who were judged during exploratory laparotomy elsewhere to suffer from non-resectable pancreatic cancer and who underwent a second-look operation after referral to our hospital.


RESULTS
During the second-look operation 13 patients (76.5 %) underwent tumour resection, where-as in 4 patients (23.5 %) the tumour remained non-resectable. An R0 resection was achieved in 9 of 13 (69 %) and an R1 resection in 4 of 13 (31 %) patients, respectively. The classic Kausch-Whipple operation was performed in 4, pylorus-preserving pancreaticoduodenectomy in 5, and left pancreatic -resection in another 4 patients. Mean survival in patients after tumour resection was increased, reach-ing 17.6 months compared to 6.5 months in patients with non-resectable pancreatic cancer.


CONCLUSIONS
Our results suggest that the prediction of resectability depends highly on the experience of the surgical team. Although considered as non-resectable during prior laparotomy else-where, the majority of patients (76.5 %) suffered from a resectable tumour disease. Moreover, most of them (69 %) underwent complete (R0) -tumour removal. Thus, complex visceral operations like pancreatic carcinoma resection should preferably be performed in high-volume centres exclusively.
Warnick
P
P
Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Augustenburger Platz 1, 13353 Berlin, Deutschland. peter.warnick@charite.de
Bahra
M
M
Andreou
A
A
Neuhaus
P
P
Glanemann
M
M
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010166:Palliative Care; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D014057:Tomography, X-Ray Computed