[Analysis of the surgical treatment of pancreas head and peri-ampullary carcinoma in 236 patients].

Between 1978 and 1987, 236 patients were admitted for cancer in the pancreas or periampullary region. In 93 patients a resection of curative intent was performed, while 88 patients underwent a palliative procedure and 55 patients no operation. The operative mortality was 9%. In the complete group of patients, age above 70 years and preoperative jaundice were of prognostic significance. A tumour size greater than 3.5 cm after resection implies a better prognosis than tumours less than 3.5 cm. The 1-, 3- and 5-year survival rates of the resected patients with pancreatic head cancer were 59%, 12% and 8% respectively, those of patients with periampullary cancer 90%, 49% and 30% respectively. After a palliative procedure or only a laparotomy survival was significantly lower (p less than 0.001), with 1-year survival of 16% and 2-year survival of 4%. After resection of curative intent for cancer of the head of the pancreas 21 cases still had microscopical remnants of tumour (T3, N1b). Survival of these patients was not significantly different from that of patients with a curative resection. Surgical resection for cancer of the head of the pancreas has to be considered as a mainly palliative treatment, but given low operative mortality (less than 10%) it is still the treatment of choice to gain longer survival and in some cases definitive cure.