The surgical management of malignant lesions of the pancreas.

Over the past 20 years, carcinoma of the pancreas has increased in incidence by 20 percent. In spite of this marked increase, there continues to be controversy in some areas regarding the proper surgical management of ductal lesions. To date, there have been 122 total pancreatectomies performed at the Mayo Clinic; 63 of these were performed for carcinoma of the pancreas. Among 21 patients treated by total pancreatectomy since 1975, there was one operative death for an overall operative mortality of 4.7 percent. During the same period of time, when 34 patients underwent partial pancreatectomy of the Whipple type, there were three postoperative deaths with an operative mortality of 8.8 percent. The three patients that expired following performance of the Whipple procedure did so as a result of leakage at the anastomosis between the pancreas and the jejunum. Endocrine and exocrine pancreatectomy management have not been a particular problem. Conclusions can be drawn that total pancreatectomy for carcinoma of the pancreas is an acceptable procedure.