[Whipple's operation for tumors of the pancreatic head and periampullar area]

Between 1986 and 1991 35 partial duodenopancreatectomies have been performed in the Clinic for visceral surgery of the University of Berne. 17 for adenocarcinoma of the pancreas and 18 for miscellaneous malignant or semimalignant pathologies such as ampullary or duodenal carcinomas, cystadenomas and distal bile duct carcinomas. The mortality was 5%. Postoperative complication was observed in 50% of cases. Leak at the pancreaticojejunal anastomosis was the most common surgical complication but healed under conservative treatment with somatostatin within few days in 5 of 6 cases. The median survival for patients with adenocarcinoma of the pancreas is 550 days, for patients with other pathologies 1200 days with some long-term survival in ampullary carcinomas. These results show on one hand that this kind of surgery can be realized with acceptable morbidity and mortality rate, on the other hand that further clinical trials in systemic adjuvant treatment are indicated especially in pancreatic cancer to improve the disappointing long-term results.