Role of surgical treatment in pancreatic carcinoma

From 1964 through 1984, we treated 810 patients for carcinoma of the pancreas. In 129 patients PDE was possible (16%). Up to 1977, we had performed Whipple's procedures, while from 1978 through 1982 total pancreatectomy was our principal procedure. Since 1983, partial PDE again has been the procedure of choice for the potentially curative treatment of pancreatic cancer. Comparing the results of both methods (60 partial/64 total), we did not find any advantages of total pancreatectomy. Operative mortality increased after total PDE and survival time related to tumor stage did not extend. The 2-year survival rate for partial PDE was 26 and for total PDE 14%. Regarding the patients with unresectable cancer of the pancreas, the rate of those not undergoing surgery rose to 25% due to better preoperative staging by modern imaging techniques, while the rate of exploratory laparotomies was reduced to 5%. Since the preoperative use of PTCD, the mortality rate of our palliative procedures dropped to 12%. The biliodigestive anastomosis of choice is the hepaticojejunostomy. Gastroenterostomy is not routinely added (6% only).