Curative and palliative surgical treatment of pancreaticoduodenal adenocarcinoma

In the period 1965 to 1976 inclusive, 55 patients suffering from duodenopancreatic adenocarcinoma were surgically treated at the Free University Hospital. Twenty of these patients underwent a 'curative' Whipple pancreaticoduodenectomy for a resectable tumor. The difference in survival time makes a differentiation important between carcinomas occurring in the head of the pancreas and those of the peri-ampullary region. In our series, 11 of the former were found and 9 of the latter group. Of each group one patient died within 30 days of the operation. The average survival time of 9 patients, operated on for a tumor in the head of the pancreas, was 10.2 months, with a range from 2 to 23 months. One patient is still alive 23 months after the operation. The average survival time of 5 patients with a periampullary tumor was 22 months with a range from 6 to 52 months. Three patients are still alive, one more than 12 years and 2 more than 19 months after operation. Considering the bad results, and the fact that 30 percent of pancreatic carcinomas are multifocal, it would seem that the classical Whipple operation is a thing of the past. One can then make a plea for total pancreaticoduodenectomy or even for a regional pancreatectomy. Thirty-five patients underwent a palliative procedure, consisting of a biliary bypass combined in a number of cases with a gastroenterostomy. Five patients died within 30 days of the operation. The average survival time for the remaining patients was 9.5 months with a range of 1.5 to 30 months.