SURGERY FOR LEFT-SIDED PANCREATIC-CANCER

A total of 590 exocrine pancreatic cancers of the body or tail of the pancreas, operated on between January 1982 and December 1988, were ana lysed. There were 128 pancreatic resections (group 1), 164 palliative bypasses (group 2) and 293 exploratory laparotomies which included 74 splanchnicectomies (group 3). The mortality rate was lower in group 1 (9 per cent) than in group 2 (19 per cent) (P = 0.012). The mortality rate exceeded 40 per cent in groups 1 and 2 for patients aged more tha n 70 years with pre-existing organ failure. The morbidity rate was 32 per cent in group 1 and 29 per cent in group 2. Patients with metastas es had a median survival of 3.4 months, whatever the operative treatme nt. In the presence of lymph node involvement there was no significant difference in survival between groups 1 and 2. Patients with no metas tases and no lymph node involvement had 1- and 3-year survival rates o f 38 and 12 per cent respectively after pancreatic resection. Only pat ients with a small tumour (less than or equal to 4 cm), no lymph node involvement and no metastases achieved a significantly better survival after resection (P=0.049). Curative resection should be reserved for a small tumour confined to the pancreas. Fewer than 10 per cent of pat ients will be suitable for surgery, For the other cases, resection mus t be considered as a palliative procedure without a significant improv ement in survival. It seems justified to limit palliative surgery to c andidates for digestive bypass and to use non-surgical palliation for the remainder.