[Surgical treatment of cancer of the pancreas]

A series of 145 patients with cancer of the pancreas is presented. Radical surgery was performed in 23 cases. An assessment is made of anatomical and clinical factors likely to interfere with the results of surgery, particularly radical surgery. The mean survival after palliative operations was 5.5 months and after duodenocephalopancreatectomy 16.1 months. After resection, operative mortality as a whole was 21.6%, though in the last 5 years it had fallen to 8.8%. Actuarial survival after 1 yr was 56.3% and after 2 yr 18.8%. The average duration of the symptom picture was long due to the difficulty of making an early diagnosis. This has an adverse influence on the operability of cancer of the pancreas. On average, survival after resection was less in cases with infiltration of the lymph nodes, but not in those with extension of the neoplasia to neighbouring organs, such as the duodenum. The results of radical management were much the same as those reported in the literature and are regarded as unsatisfactory, even though better than those achieved with palliative surgery. Their improvement is discussed in the light of the technical features of duodenocephalopancreatectomy. It is felt that extensive lymphadenectomy is required and that this should be planned and performed in accordance with strict anatomical and surgical criteria.