Adenocarcinoma of the pancreas: a statistical analysis of biliary bypass vs Whipple resection in good risk patients.

A series of 297 patients with adenocarcinoma of the head of the pancreas was reviewed. Forty-eight patients was identified with disease limited to the pancreas or adjacent tissues. Twenty-four patients underwent Whipple resection. A second group of 24 patients underwent elective biliary bypass. No patient had liver, omental or peritoneal metastases. All cases of ampullary carcinoma and islet cell tumors were excluded. Assessment of clinical and laboratory parameters revealed the two groups to be statistically comparable. There were no 5-year survivors in either groups. Mean duration of survival was not significantly different. Life table analysis showed no significant difference between the survival rates of the two groups. Frequency of clinic followup, rehospitalization and reexploration were used to assess palliation. Success of palliation was poor in both groups and no statistically significant differences were noted. Surgical mortality in the resected group was 8% and did not differ from the 4% surgical mortality in the bypass group. Surgical morbidity was significantly higher in the resected group. Implications of this data in the management of patients with resectable carcinoma of the pancreas are discussed.