Carcinoma of the pancreas and periampullary region: a 41 year experience

A retrospective review of 329 cases of adenocarcinoma of the pancreas and 31 adenocarcinomas of the ampulla and and common bile duct seen between the years 1929 and 1973 was carried out. The most common complaints for carcinoma of the pancreas were pain, weight loss, and jaundice in that order of frequency; while jaundice was the most common complaint with periampullary lesions. The most common procedure carried out was a gastric and/or biliary bypass. Thirty-five patients underwent pancreatoduodenectomy. The survival of this latter group was longer and better than those undergoing bypass and in 40% of patients with ampullary carcinoma a cure was effected. Patients undergoing bypass did not live longer than patients undergoing simple exploratory laparotomy. Duration of symptoms and location of tumor within the pancreas (excluding ampullary tumors) did not appear significantly to alter the prognosis. In view of our experience it is felt that pancreatoduodenectomy should be undertaken whenever the tumor is deemed resectable as this provides the only chance for cure and the best palliation.