Concept: Which Operations for Pancreatic Cancer

Abstract

In past decades the mortality rate of pancreatic resection ranged between 20% and 40%. Since the mortality rate far exceeded the incidence of 5-year survival, it could reasonably be argued that the results of bypass procedures were superior to resection. For the period 1953–1973, Aston and Longmire lost 13.8% of 65 patients undergoing a Whipple resection. But those patients undergoing surgery from 1963 to 1973 had a mortality rate of only 5.1%. ReMine experienced a 4.3% mortality in a recent series of total pancreatectomies, while Moosa, Lewis, and Mackie had four deaths in 52 resections (19 Whipple operations and 33 total pancreatectomies). Barton and Copeland reported a 2.3% mortality for 44 Whipple operations for ampullary carcinoma. Representative 5-year survival figures reported by Forrest and Longmire in 1979 ranged from 4% for carcinoma of the pancreas to 24% for ampullary and 25% for distal common bile duct (CBD) cancer. These patients were treated by partial pancreatoduodenectomy. Our hospital mortality is 4.8% in 21 cases.