Cancer of the pancreas and periampullary region--diagnosis and surgical therapy.

Carcinoma of the periampullary region continues to be a challenging problem. The incidence of these tumours, especially adenocarcinoma of the pancreas, has increased steadily over the last 20 years. In spite of better diagnostic techniques, the long-term survival for patients with these tumours has remained relatively unchanged. Total pancreatectomy and regional pancreatectomy have not demonstrated a survival advantage superior to that of pancreatoduodenectomy. Especially for pancreatic carcinoma, earlier diagnosis and effective adjuvant therapy are necessary. Finally, local excision of small ampullary carcinomas in high-risk surgical patients offers survival rates comparable to those of a major resection.