Current status of pancreaticoduodenectomy for periampullary carcinoma

Pancreaticoduodenectomy has undergone numerous modifications since the original description by Whipple et al. of a successful two-stage radical resection of the head of the pancreas and duodenum in 1935. For most of the 50 years that the Whipple procedure has been performed, the morbidity and mortality rates have been high, and few long-term survivors have been reported. Over the past decade, a number of institutions have reported a dramatic decline in operative morbidity and mortality as well as an improved survival for those undergoing pancreaticoduodenal resection. Between 1969 and 1986, 88 patients underwent pancreaticoduodenal resection for periampullary cancer at the Johns Hopkins Hospital. In an effort to detect recent trends in operative morbidity and mortality for those undergoing pancreaticoduodenal resection, the patients were divided into two groups on the basis of two time periods. Forty-one patients underwent pancreaticoduodenectomy for periampullary cancer between 1969 and 1981, while 47 patients underwent pancreaticoduodenectomy between 1981 and 1986. There were no significant differences between the two groups in terms of mean age, sex distribution, duration of symptoms before presentation or mean weight loss. Likewise, preoperative laboratory data were similar for both groups of patients. In addition, mean tumor size was similar in both groups, as was the incidence of positive lymph nodes. Among the 41 patients operated upon during the first period, hospital morbidity and mortality rates were 59% and 24%, respectively. In contrast, hospital morbidity and mortality rates were 36% and 21%, respectively among the 47 patients operated upon during the recent period.(ABSTRACT TRUNCATED AT 250 WORDS)