Carcinoma of the pancreas: diagnosis and treatment

We made a retrospective analysis of the hospital record of 65 cases of carcinoma of the pancreas occurring over a 16-year period at Bayley Seton Hospital, Staten Island, New York. The male sex predominated; the average age was 62.5 years. About 72% of the tumors were located at the head of the pancreas. The patients were divided into four groups: (1) those treated by pancreatoduodenectomy (Whipple resection) (14 cases), (2) those treated by bypass operations (21 cases), (3) those managed by exploration for biopsy only (12 cases), and (4) those in whom the carcinoma of the pancreas was found only at autopsy (18 cases). The operative mortality in the Whipple group was 7%; in the bypass group, 14%; and in the exploratory biopsy group, 36%. The mean survival in the Whipple group was 27.2 months with one survival more than ten years; in the bypass group, 6.5 months; and in the biopsy group, 2.6 months. Autopsy studies showed a high rate of regional and distant node metastasis, as well as nonnodal metastasis to other organs. Most of the patients died of carcinomatosis. The operative technics and the surgical literature are discussed.