Major pancreatic resections.

Abstract

A personal series of 50 major pancreatic resections has been reviewed to assess some issues of the operative decision in relation to a patient's expected outcome. An accurate histological diagnosis was not always available at the time of operation. At operation, 25 were thought to have invasive carcinoma of the pancreas and 14 to have ampullary carcinoma but the final histology demonstrated these diagnoses as accurate in 21 and 12 cases, respectively. The remaining 17 patients had a variety of histological findings which necessitated resection. Thirty-eight per cent of patients had major postoperative morbidity resulting in a median postoperative stay of 21 days after a Whipple procedure and 28 days after total pancreatectomy. The perioperative mortality rate was 6%. The median survival was 12 months for patients with invasive pancreatic carcinoma, 37 months for patients with ampullary carcinoma and 19 months for the whole group; the 5-year survival results were 13%, 40% and 25%, respectively. It is concluded that surgical resection of small pancreatic tumours is justified because some patients gain long-term survival with an acceptable risk of perioperative mortality and because the exact diagnosis may not be established at the time of surgery.