PANCREATICODUODENECTOMY FOR PANCREATIC CARCINOMA

Abstract

This study was designed to evaluate the current results of standard pancreaticoduodenectomy (SPD) and its main modifications including pylorus-preserving pancreaticoduodenectomy (PPPD) and extended pancreaticoduodenectomy (EPD) with resection of portal vein (PV) or superior mesenteric vein (SMV) for pancreatic carcinoma. Pancreatic carcinoma has been rated fifth in cancer related deaths in western countries. Despite dismal prognosis, the only chance for cure is resection by pancreaticoduodenectomy or Whipple's procedure. During the period from 1995 to 2002, a total of 36 patients with histologically proven pancreatic adenocarcinoma were managed and outcomes were analysed for operative parameters, morbidity, mortality and survival rates. Of patients with pancreatic carcinoma, 22 were male and 14 were female with a mean age of 51 (range, 38-69) years. Tumor was located in the head of the pancreas in 29 patients (81 %) and 7 (19%) in the region of the body and tail of pancreas. The surgical procedure involved SPD in 20 patients (56%), PPPD in 9 (21%) and EPD in 7 (19%). The median operative time was 5.9 hours and median intraoperative blood loss was 680 ml. When 5 deaths occurred within 30 days of operation (14% operative mortality), the most common complications were wound infection in 9 patients (25%), pancreatic fistula in 5 (14%) and delayed gastric emptying in 4 (11%). The median survival for the entire series was 18.4 months, with actuarial 1. and 2. year rates of 88% and 54%, respectively. On the other hand, when patients receiving SPD was compared to those receiving PPPD, no significant difference in survival rates was observed (p>0.05). However, median survival in patients who underwent EPD was significantly worse (p<0.05). Prognosis of pancreatic carcinoma remains poor. Surgical resection including pancreaticoduodenectomy and its other technical modifications offer the only curative chance for patients with pancreatic carcinoma. EPD can also be performed with similar morbidity and mortality rates, but without apparent survival benefits in long term.