Correlative evaluation of angiography and pancreatoductography in relation to surgery for cancer of the pancreas.

The results of preoperative angiograms and pancreatoductograms in 37 patients with cancer of the pancreas were correlated with each other, with the findings at laparotomy, and with survival times. Tumors which could not be detected by arteriography and/or pancreatography were resectable, except for those located in the uncinate process. Among the resectable tumors, those which were identified only by pancreatography were confined mostly to the parenchyma of the pancreas and were nearly 2 cm in size. Those patients were expected to have a long survival after total pancreatectomy. In contrast, those tumors which were diagnosed only by arteriography arose from the subcapsular portion of the gland or the uncinate process and showed macroscopic invasion to the capsule of the pancreas. These tumors, recurred within 1 year, despite total pancreatectomy. The resectable tumors showing both vascular and ductal invasion were more than 3 cm in size and extended far beyond the capsule of the gland, and patients with these tumors died within 1 year after operation. In this group no difference in survival time was seen among those treated by the Whipple procedure, those by total pancreatectomy, or those by resection of the total pancreas and the portal vein.