Is the Whipple procedure a better palliative option for pancreatic cancer?

In recent years, improved results with the Whipple operation have been reported because of improved case selection, thorough intraoperative assessment, aggressive nutritional management, and technical superiority. Ninety-four cases of pancreatic cancer using the Whipple procedure at the University of Oklahoma Health Sciences Center between 1980 and 1986 were reviewed. The median survival time for patients reviewed was 4.5 months; 1- and 2-year survival rates were 16% and 6%, respectively. No survivals at 5 years were observed. Those who underwent resection (Group A) survived 12.9 months with 1- and 2-year survival rates of 54% and 27%. Those undergoing bypass procedures (Group B) had a median survival time of 6 months, with 1- and 2-year survival rates of 16% and 4%. No statistical difference in survival distribution was observed between Groups A and B. The median survival time of patients receiving a staging laparotomy with no therapeutic intervention (Group C) was 2.3 months. Group D patients either refused abdominal exploration or demonstrated signs of inoperability. Surgical mortality in Groups A and B was 8% and 10%, respectively. We suggest that clinical Stage 1 and carefully selected Stage 2 cases of pancreatic cancer should be treated by pancreatoduodenectomy. Stage 3 and 4 patients warrant simultaneous duodenal-biliary by-passes.