The surgical treatment of pancreatic carcinoma.

This is a report on 501 pancreatic and periampullary cancers treated at the Mannheim Surgical Clinic during the past 11 years. Modern diagnostic measures (computerized axial tomography, endoscopic retrograde cholangiopancreatography, and angiography), while failing to detect the early operable tumors, have contributed to a rise in the rate of resectability of cancers of the pancreatic head (from 5% to 21%). Tactical problems of surgical treatment include the extent of resection required (total or partial), the rationale of preliminary biliary decompression, the symptomatic but unidentified mass in the head of the pancreas, and concomitant celiac artery stenosis. In 118 duodenopancreatectomies performed for cancer and 81 performed for severe and complicated chronic pancreatitis, the operative and hospital mortality rate was 2.5%. Of the 28 patients whose pancreatic resections for cancer occurred more than 5 years ago, 10 reached the 5-year survival limit.