CARCINOMA OF THE HEAD OF THE PANCREAS - REVIEW OF 67 CASES AND COMPARISON WITH 27 ADDITIONAL PERIAMPULLARY CARCINOMAS

Background/Aims: Carcinoma of the head of the pancreas is reported wit h increasing incidence. The classical Whipple procedure, modified by T raverso and Longmire, is a major surgical undertaking and there is que stion on a its indication in the case of lesions which, although techn ically resectable, are not susceptible to cure. Patients and Methods: We review 67 cases of carcinoma of the head of the pancreas comparing the results of radical vs. palliative surgery. The results were then c ompared with 27 additional cases of periampullary carcinomas. Results: Long term survival was obviously higher after resection, due to the m ore advanced tumor stage in, the palliation group. However, perioperat ive mortality, supposedly high in extensive resective surgery, was 8.7 % (vs 11.9% in. the palliation, group). Conclusions: At present, exten sive resective surgery carries unacceptable incidence of perioperative mortality. Therefore we suggest that indication for resection should be widened, as it may offer better chances of cure in resectable peria mpullary carcinomas and, even in non curable cases, it offers better q uality of life and the advantages of tumor debulking.