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Disappointments in the Management of Patients With Malignancy of Pancreas, Duodenum, and Common Bile Duct

Disappointments in the Management of Patients With Malignancy of Pancreas, Duodenum, and Common... Abstract Only 8% of cancers of the pancreas, duodenum, and common bile ducts, in patients admitted over a 14-year period, qualified for curative resections. To date, among 275 cases, there is but one five-year survivor. In spite of these disappointments, a nihilistic approach to pancreaticoduodenal malignancy is not warranted. Patients receiving palliative procedures survived longer than those without surgery, and pancreaticoduodenectomy generally afforded a longer survival than patients undergoing palliative procedures. Among the patients with resectable lesions of the ampulla of Vater, there were no postoperative deaths even though all but two were in the seventh decade. These patients represent survivals so far from 9 to 74 months. The increasing incidence of cancer of the pancreas makes apparent an increased need for the training of the surgeon well versed in the performance of pancreatic resection. References 1. Glenn F, Thorbjarnarson B: Carcinoma of the pancreas . Ann Surg 159:945-958, 1964.Crossref 2. Fish JC, Cleveland BR: Pancreaticoduodenectomy for periampullary carcinoma: Analysis of 38 cases . Ann Surg 159:469-476, 1964.Crossref 3. Longmire WP, Shafey OA: Certain factors influencing survival after pancreaticoduodenectomy for carcinoma . Amer J Surg 111:8-12, 1966.Crossref 4. Karmody A, Kyle J: Diabetes mellitus and carcinoma of the pancreas . Bull Soc Int Chir 36:119-123, 1968. 5. Shamblin WR, Priestley JT, Sprague RG, et al: Total pancreatectomy for pleomorphic carcinoma: A five-year cure . Arch Surg 92:315-317, 1966.Crossref 6. Neilson RO, et al: A ten-year experience with carcinoma of the pancreas . Arch Surg 94:322-325, 1967.Crossref 7. Collins JJ Jr, Craighead JE, Brooks JR: Rationale for total pancreatectomy for carcinoma of the pancreatic head . New Eng J Med 274:599-606, 1966.Crossref 8. Heilbrunn A, and Zimmerman JL: Pancreatic tumors: The fate of patients with carcinoma of the pancreas . J Kansas Med Soc 66:388-390, 1965. 9. Jordan GL: Surgical management of carcinoma of the pancreas and periampullary region . Amer J Surg 107:313-316, 1964.Crossref 10. Judd ES: Surgery of the biliary tract and pancreas . Mayo Clin Proc 39:927-938, 1964. 11. Morris PJ, and Nardi GL: Pancreaticoduodenal cancer: Experience from 1951 to 1960 with a look ahead and behind . Arch Surg 92:834-837, 1966.Crossref 12. Neto MX, Woodhaus JA, Goodsitt E: Carcinoma of the pancreaticoduodenal area: A five-year study in a community hospital . Ohio Med J 60:141-144, 1964. 13. Rastogi H, Brown CH: Carcinoma of the pancreas: Review of 100 cases . Cleveland Clin Quart 34:243-244, 1967.Crossref 14. Rodriques-Autunez A, Felson EJ, Sullivan BH, et al: Photoscanning in the diagnosis of carcinoma of the pancreas . Ann Intern Med 65:730-734, 1966.Crossref 15. Sato T, et al: Preoperative determination of operability in carcinoma of the pancreas and periampullary region . Ann Surg 168:876-886, 1968.Crossref 16. Smith PE, Krementz ET, Reed RJ, et al: An analysis of 600 patients with carcinoma of the pancreas . Surg Gynec Obstet 124:1288-1290, 1968. 17. Warren KW, Braasch JW, Thum CW: Diagnosis and surgical treatment of carcinoma of the pancreas . Curr Probl Surg 2:1-70, 1968. 18. Mongé JJ, Dockerty MB, Wollaeger EE, et al: Clinicopathologic observations on radical pancreaticoduodenectomy for periampullary carcinoma . Surg Gynec Obstet 118:275-283, 1964. 19. Statistics on cancer . CA 18:13-15, 1968. 20. Moldow RE, Connelly RR: Epidemiology of pancreatic cancer in Connecticut . Gastroenterology 55:677-686, 1968. 21. Child CG III, Frey CF: Pancreaticoduodenectomy . Surg Clin N Amer 46:1201-1213, 1966. 22. Mongé JT, Judd ES, Gage RP: Radical pancreaticoduodenectomy; A 22-year experience with complications, mortality, and survival rate . Ann Surg 160:711-722, 1964.Crossref 23. Sako Y: Surgical experience with carcinoma of the pancreas and the ampulla of Vater . Progr Clin Cancer 2:309-317, 1966. 24. Howard JM, Jordan GL Jr: Surgical Disease of the Pancreas . Philadelphia, JB Lippincott Co, 1960, p 461. 25. Buckwalter JA, Lawton RL, Tidrick RT: Pancreaticoduodenectomy . Arch Surg 89:331-339, 1964.Crossref 26. Howard JM: Forty-one consecutive Whipple resections without an operative mortality . Ann Surg 168:629-640, 1968.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Disappointments in the Management of Patients With Malignancy of Pancreas, Duodenum, and Common Bile Duct

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Publisher
American Medical Association
Copyright
Copyright © 1970 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1970.01340280013004
Publisher site
See Article on Publisher Site

Abstract

Abstract Only 8% of cancers of the pancreas, duodenum, and common bile ducts, in patients admitted over a 14-year period, qualified for curative resections. To date, among 275 cases, there is but one five-year survivor. In spite of these disappointments, a nihilistic approach to pancreaticoduodenal malignancy is not warranted. Patients receiving palliative procedures survived longer than those without surgery, and pancreaticoduodenectomy generally afforded a longer survival than patients undergoing palliative procedures. Among the patients with resectable lesions of the ampulla of Vater, there were no postoperative deaths even though all but two were in the seventh decade. These patients represent survivals so far from 9 to 74 months. The increasing incidence of cancer of the pancreas makes apparent an increased need for the training of the surgeon well versed in the performance of pancreatic resection. References 1. Glenn F, Thorbjarnarson B: Carcinoma of the pancreas . Ann Surg 159:945-958, 1964.Crossref 2. Fish JC, Cleveland BR: Pancreaticoduodenectomy for periampullary carcinoma: Analysis of 38 cases . Ann Surg 159:469-476, 1964.Crossref 3. Longmire WP, Shafey OA: Certain factors influencing survival after pancreaticoduodenectomy for carcinoma . Amer J Surg 111:8-12, 1966.Crossref 4. Karmody A, Kyle J: Diabetes mellitus and carcinoma of the pancreas . Bull Soc Int Chir 36:119-123, 1968. 5. Shamblin WR, Priestley JT, Sprague RG, et al: Total pancreatectomy for pleomorphic carcinoma: A five-year cure . Arch Surg 92:315-317, 1966.Crossref 6. Neilson RO, et al: A ten-year experience with carcinoma of the pancreas . Arch Surg 94:322-325, 1967.Crossref 7. Collins JJ Jr, Craighead JE, Brooks JR: Rationale for total pancreatectomy for carcinoma of the pancreatic head . New Eng J Med 274:599-606, 1966.Crossref 8. Heilbrunn A, and Zimmerman JL: Pancreatic tumors: The fate of patients with carcinoma of the pancreas . J Kansas Med Soc 66:388-390, 1965. 9. Jordan GL: Surgical management of carcinoma of the pancreas and periampullary region . Amer J Surg 107:313-316, 1964.Crossref 10. Judd ES: Surgery of the biliary tract and pancreas . Mayo Clin Proc 39:927-938, 1964. 11. Morris PJ, and Nardi GL: Pancreaticoduodenal cancer: Experience from 1951 to 1960 with a look ahead and behind . Arch Surg 92:834-837, 1966.Crossref 12. Neto MX, Woodhaus JA, Goodsitt E: Carcinoma of the pancreaticoduodenal area: A five-year study in a community hospital . Ohio Med J 60:141-144, 1964. 13. Rastogi H, Brown CH: Carcinoma of the pancreas: Review of 100 cases . Cleveland Clin Quart 34:243-244, 1967.Crossref 14. Rodriques-Autunez A, Felson EJ, Sullivan BH, et al: Photoscanning in the diagnosis of carcinoma of the pancreas . Ann Intern Med 65:730-734, 1966.Crossref 15. Sato T, et al: Preoperative determination of operability in carcinoma of the pancreas and periampullary region . Ann Surg 168:876-886, 1968.Crossref 16. Smith PE, Krementz ET, Reed RJ, et al: An analysis of 600 patients with carcinoma of the pancreas . Surg Gynec Obstet 124:1288-1290, 1968. 17. Warren KW, Braasch JW, Thum CW: Diagnosis and surgical treatment of carcinoma of the pancreas . Curr Probl Surg 2:1-70, 1968. 18. Mongé JJ, Dockerty MB, Wollaeger EE, et al: Clinicopathologic observations on radical pancreaticoduodenectomy for periampullary carcinoma . Surg Gynec Obstet 118:275-283, 1964. 19. Statistics on cancer . CA 18:13-15, 1968. 20. Moldow RE, Connelly RR: Epidemiology of pancreatic cancer in Connecticut . Gastroenterology 55:677-686, 1968. 21. Child CG III, Frey CF: Pancreaticoduodenectomy . Surg Clin N Amer 46:1201-1213, 1966. 22. Mongé JT, Judd ES, Gage RP: Radical pancreaticoduodenectomy; A 22-year experience with complications, mortality, and survival rate . Ann Surg 160:711-722, 1964.Crossref 23. Sako Y: Surgical experience with carcinoma of the pancreas and the ampulla of Vater . Progr Clin Cancer 2:309-317, 1966. 24. Howard JM, Jordan GL Jr: Surgical Disease of the Pancreas . Philadelphia, JB Lippincott Co, 1960, p 461. 25. Buckwalter JA, Lawton RL, Tidrick RT: Pancreaticoduodenectomy . Arch Surg 89:331-339, 1964.Crossref 26. Howard JM: Forty-one consecutive Whipple resections without an operative mortality . Ann Surg 168:629-640, 1968.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1970

References