[Cephalic gastroduodenopancreatectomy in cancer of the duodenobiliopancreatic crossover].

Over a period of 29 years (1949--1977) a total of 50 extended gastroduodenopancreatectomies have been performed in 309 patients with cancer of the subhepatic region. The indication for this type of surgery was determined by: 20 malignant lesions of the head of the pancreas, 14 cancers of the Vater ampula, 10 neoplasies of the juxta-vaterian duodenal portion, and 6 stenosing malignant tumors of the terminal choledocus. The major operation, of long duration, employed in radical oncologic treatment, entailed 13 postoperative deaths (26%) and resulted in an average survival of 2 years. Eight of the patients were alive after a follow-up of 5 years. The Child procedure was used 32 times, the remaining cases being operated according to a personal technique, in two variants. The results of paleative interventions are discussed in parallel. These consisted in simple bilio-digestive derivations. Based on the authors personal experience, and considering the data published in the specialized literature it may be postulated that oncologic surgery, such as that applied in extended gastroduodenopancreatectomy is fully justified when general and intra-operative conditions allow such interventions. The results depend, to a large extent, on the early diagnosis of these cancers.