Pancreatic carcinoma: surgical treatment

There is controversy in the literature over the surgical treatment of pancreatic carcinoma, especially whether gastro-enterostomy should be performed prophylactically when palliative biliary bypass is done. The authors report a retrospective study of 184 patients with pancreatic carcinoma treated at the Hôtel-Dieu Hospital in Montreal between 1970 and 1982. Of these, 106 patients had cancer of the head of the pancreas. In this group, 15 had a Whipple procedure. Median survival was 512 days with no 5-year survivors. Forty-nine patients had biliary bypass alone and 3 needed gastroenterostomy later for duodenal obstruction. Eleven patients had both biliary--enteric bypass and gastroenterostomy. Biliary bypass using the common duct gives the same result as that using the gallbladder. Considering their reoperation rate of only 7.3%, the authors do not believe that prophylactic gastroenterostomy is indicated in these patients.