Total pancreatectomy and subtotal duodenopancreatectomy for the management of carcinoma of the head of the pancreas: an institutional experience and evolving trends.

Abstract

This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Initially in 1973 total pancreatectomy was the treatment of choice. Our policy changed after a review of 47 consecutive total pancreatectomies in 1986 which showed no benefit. From 1986 the Whipple procedure became our standard operation. In the following 41 patients, a Whipple procedure was performed in 19 patients, and a total pancreatectomy was still performed in 22 patients because of positive resection margins or a friable pancreatic remnant. After total pancreatectomy, the 5-year survival rate was 7.8%. For lymph-node-negative patients, the 1-, 3-, and 5-year survival rates were 54, 24, and 15%, respectively. For node-positive patients, the 1-and 3-year survival rates were 46 and 4%, respectively, and there were no survivors at 54 months. This difference was statistically not significant. After the Whipple procedure, the 5-year survival rate was 12.5%. For node-negative patients, the 1-, 3- and 5-year survival rates were 50, 59, and 25%, respectively. For node-positive patients, the 1-year survival rate was 21%. This difference was significant (p = 0.007). This study highlights the fact that extended radical surgery does not improve overall survival, but stage II and III disease (Hermreck classification) was associated with a prolonged survival. © 1996 S. Karger AG, Basel.