Surgery of carcinoma of the pancreas

The surgical treatment of pancreatic cancer depends upon the site and extent of the tumour and in particular the experience of the surgeon, as pancreatic resection performed outside specialized centres carries a high risk. Within the specialized unit the Whipple operation is the treatment of choice for periampullary carcinomas, but the results of resection for more extensive tumours of the pancreatic head are disappointing even with adjuvant chemotherapy and radiotherapy. Resection, however, provides the only prospect of cure and may be the best palliative procedure. The place of total and "regional" pancreatectomy is undecided. The choice of palliative operations to relieve malignant biliary, duodenal and pancreatic duct obstruction should be carefully considered to avoid early recurrence of symptoms. The prognosis for patients with cancer of the body of the pancreas remains poor.