[Neoplasms of the head and tail of the pancreas]

The majority of cancer of the pancreas-about 70%-arise in the head of the gland and only 20-30% in the body and tail. The latter usually have grown to a large size by the diagnosis is made, due to absence of symptoms. Jaundice is seldom present and pain is the main symptom. We reviewed recent literature, which present homogeneous data. Cancers of the body and tail are rarely resectable, with 30% morbidity and a much lower morbidity-0-10%-in specialized centres. If the lesion is localized and the patient in good physical condition, a laparotomy can be performed, with or without a preliminary laparoscopy to detect distant metastases. Distal pancreatectomy and splenectomy is the treatment of choice. In our experience, only tumors different from ductal adenocarcinoma have a good prognosis. Pain can be managed by surgical or chemical splanchnicectomy and, in selected cases, thoracoscopically.