COULD THE CARCINOMAS OF THE HEAD OF THE PANCREAS BE CAUGHT EARLY ENOUGH?

Abstract

Between 1990-1993 in the Department of General Surgery, Uludağ University Faculty of Medicine, 46 cases of carcinoma of the head of the pancreas were evaluated retrospectively.

Mean age was 62.5 (40-82) years and the male/female ratio was 2.06. While all of the cases had dyspeptic complaints, 93% of (hem were jaundiced. Fifty one percent of the cases had coexistent diseases. According to laboratory findings, 69% of the cases had deterioriation in the liver function tests and 95% of the cases had hypoalbuminemia.

A mass was identified in the region of the head of the pancreas in 67.5% of patients evaluated ultrasonographically. In 22.2% of the patients ultrasonography only revealed findings attributable to bilier tract obstruction while In 5 cases ultrasonography was normal. In 97.5% of the cases, computed tomography correctly determined the masses in the head of the pancreas. Thirty six (78.2%) of the cases were operated on. In 6 cases which were accepted as inoperable, external percutaneus biliary drainage catheterisation was performed. One of the remaining 4 patients refused any therapeutical intervention while 3 of them died during diagnostic studies period. Whipple procedure was performed in 13.9% of patients who were operated on, while 75% of them underwent biliary bypass procedures. In the remaining 4 cases (11.1%) only laparotomy was performed. Three patients died in the intraoperative and early postoperative period. Among the patients whose follow up were established, median survival was 10.3 months for patients who underwent Whipple procedure, 4.1 months for patients on which by-pass procedures was performed and 2 months for patients on which percutaneus drainage was performed. In our study the operative mortality was determined as 8.3% while overall mortality was 13%. This study showed that, pancreatic head carcinomas, which according to the literature are assumed to cause symptoms earlier than the carcinomas located in the body or tail of the pancreas are caught too late in our center and the chance for radical operation is very low.