Operative therapy for pancreatic carcinoma.

The prognosis for patients with pancreatic adenocarcinoma remains dismal. The operative management of 116 patients with pancreatic adenocarcinoma treated over a 15 year period was reviewed. Biliary bypass was associated with a high operative mortality (33 percent). Cholecystojejunostomy was associated with a 27 percent incidence of recurrent obstructive jaundice before death. Therefore, it is recommended that when feasible, a choledochojejunostomy be performed. A 25 percent incidence of duodenal obstruction was observed in patients who did not routinely undergo prophylactic gastroenterostomy. Survival was short in all patients whether or not a resection was performed: the mean survival after biliary bypass was 5.6 months. A significant problem was observed in patients who underwent pancreaticoduodenectomy. Tumor was present at the line of transection of the pancreas in the majority of patients. Thus, it is strongly recommended that frozen section examination of the margin of the pancreas be carried out routinely if a partial pancreatectomy is performed. Newer techniques of palliation for patients with pancreatic carcinoma such as fine needle aspiration biopsy guided by computerized axial tomography and internal or external biliary stenting are encouraged due to the high operative mortality and short survival of all patients with pancreatic adenocarcinoma. There were no long-term survivors after radical pancreaticoduodenectomy in this series.