[Therapeutic strategy in carcinoma of the exocrine pancreas]

A series of 311 consecutive patients undergone surgery for pancreatic carcinoma in the Department of General Surgery from July 1979 to March 2003. We performed 41 standard pancreaticoduodenal resections (13%: 30 DCP, 2 total pancreatectomies, 9 splenopancreatectomies), 235 by-passes (75.5%: 114 Roux-en-Y hepaticojejunostomies, 99 hepaticojejunostomies with GEA, 22 GEA), 35 explorations and biopsy (11.2%: 28 LE and 7 VLS). Mortality rate was: 2.4% in Resection, 3.7% in BB(+)-GEA, 18.8% in GEA, 0% in LE-VLS. Morbidity rate was: 43.9% in resection (pancreatic fistula 21.9, haemorrhage 12.1, pneumonia 4.8, infection and delayed gastric emptying 2.4), 10.3% in BB(+)-GEA, 27% in GEA, 5.7% in LE. Actual survival rate was at 3 and 5 years after resection 9.7% and 4.8% respectively with median 18 months; mean survival was after by-pass 11 months (min 3, max 38) with median 9 months.