The Whipple procedure and other standard operative approaches to pancreatic cancer

In a series of 50 patients with cancer of the pancreas who wee undergoing resection of the pancreatic head and the duodenum, the average survival was 16.2 months. If the resected margin was free of tumor the average survival was 20.3 months. In 103 less favourable cases treated by biliary bypass, with or without gastroenterostomy, the average survival was only 6.2 months. Although these series are not comparable, pancreaticoduodenal resection for cancer of the pancreas and periampullary area has been utilized in cases without distant metastases in an effort to extend the period of palliation and to achieve occasional long-term survival. Currently available diagnostic techniques may permit earlier diagnosis and improved results. A positive tissue diagnosis is not essential before proceeding with resection, but this aspect of the operation should be fully discussed with the patient. An unfavorable condition of the residual pancreas for anastomosis, or a positive frozen section examination of the pancreas at the line of transection may indicate total pancreatectomy, but complete resection is not used routinely. The incidence of jejunal ulceration, a serious late postoperative complication, may be reduced by utilizing a 60-70% gastric resection or antrectomy and vagotomy.