Operation of choice for resectable carcinoma of the head of the pancreas.

What is the best procedure for resectable carcinoma of the head of the pancreas? In order to respond to the question, a retrospective study was performed based on 510 cases with carcinoma of the head of the pancreas that were experienced from 1975 to 1984 at nine major surgical institutions in Japan. Laparotomized cases (504) were divided into four groups according to operative procedures: pancreatoduodenectomy (PD), total pancreatectomy (TP), regional pancreatectomy (RP), and palliative operation (PO). The postoperative cumulative survival rate (PCSR) was calculated on each group. Although the five year survival rate of PO was 0, those of PD, TP, and RP were 11.2, 4.6, and 4.5%, respectively. There was a significant difference between PD and TP (p less than 0.01) according to generalized Wilcoxon's test. TNM stage grouping was applied to 447 cases that had adequate descriptions on T, N, and M categories. PCSR was calculated on PD, TP, and RP at each stage. It was found in Stage III that survival curve of PD was significantly higher than TP (p less than 0.01), according to generalized Wilcoxon's test. It seems that PD is the best procedure, but it should be accompanied by extensive lymph node and retroperitoneal tissue dissection.