Analysis of pancreatoduodenectomy

Between 1956 and 1982, there were 55 pancreatoduodenectomies performed at the Medical University of South Carolina by 19 different surgeons. There were 26 resections for adenocarcinoma of the head of the pancreas and 16 resections for carcinoma of the ampulla of vater, carcinoma of the extrahepatic biliary ducts, and carcinoma of the duodenum. There were seven resections for chronic pancreatitis. There were two resections for trauma and three resections in the (1960s) for carcinoma of the stomach. There was one resection for cystadenocarcinoma of the pancreas. In the patients with carcinoma of the pancreas, resection was only performed when there was no gross evidence of extension beyond the parenchyma of the pancreas. Analysis of the resected specimen revealed 44% of the pancreatic carcinomas subsequently had positive lymph nodes. None of these patients became long-term survivors. Failure of the pancreato-jejunostomy was the most serious complication, occurring in 7 of 55 resections. There were no fistulas where a mucosal to mucosal anastomosis was performed to join the pancreas with the jejunum. The five-year survival for all patients with carcinoma of the pancreas was 11.6%. The 3 five-year survivors were from resections performed between 1956 and 1970. During these years, the mortality rate for the procedure was 21%. From 1970 to 1982 there were no five-year survivors from carcinoma of the pancreas. However, the mortality rate was 10.6%. The history and current controversies over this surgical procedure are reviewed.