[Pancreaticoduodenectomy (Whipple's operation) for periampullary cancer]

This study evaluated the indications for and effects of pancreaticoduodenectomy (102 patients) or total pancreatectomy (15 patients) with extensive lymph node dissection performed upon 117 patients with periampullary adenocarcinoma. Presenting symptoms and postoperative morbidity and mortality rates were recorded. Cumulative survival rates were evaluated in relation to origin, size, and staging of tumour. The postoperative mortality rate after Whipple's operation was 8% (eight patients). The median survival period was 1.1 year and the overall five year survival rate was 15% (confidence limits, 5 to 25%). The five year survival rate for patients without tumour extension beyond the pancreas was 25% (confidence limits, 5 to 50%), and in patients with adenocarcinoma of the ampulla af Vater, 34% (confidence limits, 3 to 65%). The median survival rate in patients with adenocarcinoma of the ampulla of Vater was 3.3 years, which was significantly longer than in the other patients. Fifty-nine patients with distant spread could be divided into 14 patients with para-aortic lymph node metastases who had a significantly shorter survival period than 45 patients without para-aortic lymph node metastases (p = 0.004). Resection of periampullary carcinoma provides a better palliation and survival rate than nonoperative biliary drainage or bypass operation. An improved preoperative verification of para-aortic metastases could restrict resection to patients with a prognostic five year survival rate of more than 25% and a postoperative mortality rate of less than 5%.