Pancreatic and periampullary carcinoma.

During the 10-year period from 1972 to 1981, 179 patients were treated for pancreatic and periampullary carcinoma (40 resections, 91 bypasses, 39 laparotomies and 9 non-operated) in Oulu University Central Hospital. Mortality after resections was 10% and complication rate 33%. In 1977-1981, mortality after resections decreased from 30 to 3% (p less than 0.05) but resectability or survival did not improve. Median survival following resection for pancreatic and periampullary carcinoma was 8 and 34 months (p less than 0.001). The 5-year cumulative survival rate for resected periampullary carcinomas was 42 +/- 16%. We conclude that 5-year survival after resection for periampullary carcinoma is significantly better than after resection for pancreatic carcinoma. The effect of modern imaging techniques on resectability and survival is negligible. Age as such is not a limiting factor for resection. We recommended a prophylactic duodenal bypass is conjunction of biliary diversion for unresectable carcinoma. The acceptable mortality after resection encourages us to continue an aggressive policy in surgical treatment. However, attention should be drawn to a more careful patient selection and proper preparation.