Is resection appropriate for adenocarcinoma of the pancreas? A cost-benefit analysis.

Our data support the contention that biliary bypass combined with gastric bypass is the treatment of choice for the majority of patients with adenocarcinoma of the pancreas. Compared with resection, operative morbidity and mortality rates were lower, length of hospitalization was shorter, and the cost of treatment was lower. There was no significant difference in survival. In choosing candidates for resection, the surgeon must balance the meager chances for cure (less than 1 percent) with the considerable operative hazard and the risk of lethal, costly complications. In our view, resection should be considered only for physiologically young patients with small localized lesions. These patients should be referred to surgeons specializing in pancreatic surgery who have had operative mortality rates of less than 10 percent. Pancreatic resection must, therefore, be deprived of its appeal as a procedure to which every surgeon must aspire.