Is there still a place for Whipple's operation?

During a 12 year period 42 patients underwent a pancreatoduodenectomy, on 35 occasions because of malignancy. Four patients (11%), all with pancreatic cancer, died in the postoperative period. Two of the seven patients with pancreatitis died (28%). No patient with pancreatic cancer survived one year. Seven of the 11 patients with distal common bile duct cancer survived one year and five out of seven patients with carcinoma of the ampulla of Vater survived one year. Local tumor recurrence occurred in at least 18 of 27 patients (67%), upper abdominal pain being the most important symptom. At long follow-up three patients had tumor recurrence in the laparotomy scar. In our experience resection offers the only chance of cure for patients with a tumor of the ampulla of Vater or the distal common bile duct. At present, however, resection is not the treatment of choice in patients with pancreatic cancer.