[Surgical aspects of space-occupying lesions in the pancreas]

A mass in the head of the pancreas is always a challenge, and the differentiation between malignancy and the chronic inflammation even in the course of the operation is nearly impossible. The number of these type of pancreatic lesions is increasing. The basic diagnostic tools are the sonography and the endoscopic pancreatography, and a useful possibility is the percutaneous or intraoperative fine needle biopsy. In the case of a space-reducing tendency of the lesion the surgical intervention is mandatory--in some cases (jaundice, etc.) the solution can be performed in two-stages. These patients should be treated in departments with special interest and practice concerning these lesions, at least at the stage of definitive surgery. In the author's modest practice in the course of a 13 year period on two hospital departments there were operated upon 176 patients with 211 surgical interventions. There were made 48 radical pancreatic resections (Whipple-procedures 28, body-tail resections 17 and 3 total pancreatectomies) with an acceptable mortality--there was only one death among the 28 duodenopancreatectomies. It is emphasized, that the best palliation is the resection, the Whipple-procedure can be performed without any pancreatodigestiv anastomosis, and the usual complication of this method, the pancreatic fistula can be prevented by a simple pancreatogastrostomy. The patients underwent these types of surgery need a long-term postoperative care. The nihilism of pancreatic malignancies is obsolete.