PANCREATODUODENECTOMY (WHIPPLE’S PROCEDURE) FOR THE MENAGEMENT OF CARCINOMA OF THE PANCREAS – OWN EXPERIENCE AND 20-YEAR SERIES
Abstract
Background. Pancreatoduodenectomy – the procedure of choice in patients with pancreatic head cancer – has the reputation as a high risk operation with frequent postoperative complications, high postoperative mortality and poor 5-year survival. The development of the operative technique in the world and in Slovenia is presented. The autor’s own 20-year series of patients resected by this method is analysed.
Patients and methods. In the period from Jan. 1981 to Dec. 2000 the author resected 58 patients with pancreatic head or periampular cancer. They underwent presumably radical or only paliative procedure (R0, R1, R2) – 30 patients with periampullary tumours and 28 patients with ductal adenocarcinoma. In 52 patients classical Whipple pancreatoduodenectomy was performed and in 6 patients pylorus preserving pancreatoduodenectomy. In 8 patients it was necessary to enlarge the resection – 4 times to partial resection of portal vein, once to total pancreatectomy, once to extended right hemicolectomy and twice to simultaneous resection of liver methastasis.
Results. During postoperative course 6 patients had to be reoperated for surgical complications. Three patients died in the 30 days after operation – postoperative mortality rate 5.2%. Five-year survival rate is known only for the patients who are Slovene residents (38/58). Among them 5 patients lived longer than 5 years (107, 100, 87, 80 and 69 months). At the end of 2001 only 4 resected patients were alive – 2 women (3.5 and 3 years after surgery) and 2 men (4 and 3.5 year after surgery). The 5-year survival rate calculated by Kaplan-Meier method is 22.6%.
Conclusions. In spite of numerous postoperative complications and high postoperative mortality pancreatoduodenectomy is the method of choice in pancreatic head cancer patients. It is possible to improve the outcome to lower the postoperative mortality below 5% and to raise the 5-year survival of resected patients over 25%.
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References
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