OUTCOME OF MICROSCOPICALLY NONRADICAL, SUBTOTAL PANCREATICODUODENECTOMY (WHIPPLES RESECTION) FOR TREATMENT OF PANCREATIC HEAD TUMORS

From 1983 to 1992 a total of 240 patients with a pancreatic head tumor underwent laparotomy to assess the resectability of the tumor. In 44 patients the tumor was not resected because of distant metastases (n = 20) or major vascular involvement or local tumor infiltration (n = 24 ) not detected during the preoperative workup. A palliative biliary an d gastric bypass was performed in these patients. All other patients u nderwent a subtotal (Whipple's resection, n = 164) or total (n = 32) p ancreaticoduodenectomy. However, in 56 cases after Whipple's resection , microscopic examination of the specimen showed tumor invasion in the dissection margins. For this reason, these resections were considered palliative. We compared hospital mortality, morbidity, and long-term survival of patients who had undergone a biliary and gastric bypass fo r a locally advanced tumor (group A, n = 24) with a matched group of p atients who had undergone a macroscopically radical Whipple's resectio n that on microscopic examination proved to be nonradical (group B, n = 36). Both groups mere comparable with regard to age (mean 61 years i n both groups), duration of symptoms (8 weeks in group A and 10 weeks in group B), and tumor size (mean 4.25 cm in group A and 4.30 cm in gr oup B). Median postoperative hospital stay was 18 days in group A and 25 days in group B. Postoperative complications (intraabdominal absces s, gastrointestinal hemorrhage, anastomotic leakage, delayed gastric e mptying) occurred in 33% of patients in group A and in 44% of patients in group B. Hospital mortality was 0% and 3% in group A and group B, respectively. Survival in group B was significantly longer than in gro up A (p < 0.03). Survivals after 1 and 2 years were 22% and 2% in grou p A versus 44% and 24% in group B, respectively. These results support our view that when a macroscopically radical resection seems feasible , a Whipple's resection should be carried out. In case of microscopic, residual tumor, the Whipple procedure offers acceptable palliation.