SURGERY FOR PERIAMPULLARY AND PANCREATIC-CARCINOMA - A LIVERPOOL EXPERIENCE

The development of a single-surgeon specialist referral practice for p ancreatic surgery which evolved over an 8 year period is described. So urce of referral, protocol for patient management, and operative strat egy are outlined. Preoperative endoscopic retrograde cholangiopancreat ography (ERCP), endoscopic sphincterotomy, and stent placement where p ossible (85% of cases), high-resolution contrast-enhanced CT and stand ard pylorus-preserving pancreaticoduodenectomy with a unique reconstru ctive technique were employed. In 105 patients receiving curative rese ction for pancreatic or periampullary tumours, the overall operative m ortality was 4.8% and overall morbidity 26%. Actuarial 5-year survival rates were 11% for pancreatic carcinoma and 34% for ampullary carcino ma. Resectability rate was 81% without the use of time-consuming and e xpensive imaging techniques for staging such as laparoscopy, intraoper ative ultrasound or laparoscopic ultrasound. No specific regimen of pe rioperative chemoirradiation was utilised over the study period. To ac hieve comparable results it is recommended that patients should be ref erred to regional specialist surgeons in whose hands mortality and mor bidity is low, costs reduced and training of pancreatic surgeons can b e undertaken.