Pancreatic resection for carcinoma of the pancreas and the periampullary region. A twenty-year experience.

410 patients were treated for pancreatic and periampullary carcinoma in 1968-1987 of whom 89 (21.5%) underwent resection. Hospital mortality decreased from 33% in 1968-1972 to 0% in 1983-1987, but the morbidity rate remained unchanged. The trends were similar in patients greater than or equal to 70 and less than 70 years of age. The pylorus-saving technique did not increase mortality, morbidity, operative blood loss or the incidence of delayed gastric emptying, but it did reduce the operative time by one hour (p less than 0.01). The real 5 year survival for periampullary cancer was 52%, but none of the patients with pancreatic carcinoma survived for 5 years. It is concluded that age as such is not a limiting factor for pancreatic resection. Resection can be performed with acceptable mortality and survival rates even in patients over 70 years of age if enough attention is paid to careful patient selection and proper preparation. The long-term prognosis is nevertheless related to tumour histology. 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, provided that this can be performed with minimal risk.