Operative approach to pancreatic carcinoma.

It is apparent that we are dealing with a very lethal disease. It is also apparent that this disease is increasing in frequency. In terms of treatment, it is clear that the survival figures between carcinoma of the pancreas and carcinoma of the common duct, papilla of Vater, or duodenum present great differences. The pancreatic tumors do very poorly by comparison. A comparison of the survival figures following a Whipple resection and following a bypass procedure reveal similar results, except when dealing with a very small pancreatic head lesion or when dealing with a malignancy of the papilla of Vater, lower end of common duct, or duodenum. The latter tumor types do better with a Whipple resection than a bypass. A comparison between total pancreatectomy and a Whipple resection for ductal carcinoma of the pancreatic head reveals better results in terms of length of survival following total pancreatectomy as long as one considers only Stage I or Stage II disease and excludes Stage III disease. A Whipple procedure is advocated for carcinoma of the papilla of Vater, common duct, or duodenum, because survival figures are quite good and many patients escape the need for insulin and pancreatic extract replacement. It is too early to evaluate the survival figures that follow regional pancreatectomy.