Results of pancreatoduodenectomy for carcinoma of the head of the pancreas.

Seventy-eight patients underwent either pancreatoduodenectomy (88%) or total pancreatectomy (12%) for carcinoma of the head of the pancreas. The operative mortality decreased from 27% in 1968-1977 to 3% in 1978-1987. There was no operative mortality during the last 5-year period 1983-1987. Mortality (9% vs 7%) and morbidity (57% vs 42%) were similar in patients aged greater than or equal to 70 and less than 70 years. The pylorus-preserving technique did not increase mortality or operative blood loss, but it did reduce the operative time about by one hour (p less than 0.05). The actuarial 5-year survival for periampullary cancer was 40 +/- 9%, but none of the patients with pancreatic adenocarcinoma survived for 5 years (p less than 0.001). The long-term survival for radical resection was 33 +/- 8%, whereas no patient who underwent palliative resection survived for 3 years (p less than 0.001). The actuarial 5-year survival rates for patients greater than or equal to 70 and less than 70 years of age were 18 +/- 12% and 31 +/- 12% (p greater than 0.2), respectively. It is concluded that age as such is not a limiting factor for pancreatoduodenectomy. It can be performed with acceptable mortality and morbidity rates even on patients over 70 years of age. The long-term prognosis is nevertheless related to tumor histology and radicality of resection. The recent decline in operative mortality is mostly due to the resections being performed by the same group of surgeons. The best biopsy, and also palliation, is radical removal of the suspicious mass, providing that this can be performed with minimal risk.