Pancreatic carcinoma. Second-look operation?

From a total of 146 patients with carcinoma of the head of the pancreas and preiampullary region, treated surgically, 31 underwent Whipple's pancreaticoduodenectomy. Eighteen were carried out at the initial laparotomy and thirteen at a second-look operation (SLO). Of the 128 patients who underwent bypass as palliative procedure, 36 were selected. All were less than 65 yr of age, and their general condition continued to improve postoperatively. They were reassessed regularly with view to SLO. Whipple's procedure was accomplished in 13 cases. Ten out of 13 patients had a raised serum amylase at the initial exploration, indicating coexisting pancreatitis. SLO should be considered in fit patients with evidence of concomitant acute pancreatitis at the initial laparotomy, since pancreatitis can make some tumors seem locally invasive and hence unresectable at the initial laparotomy.