Carcinoma of the head of the pancreas. Therapeutic implications of endoscopic retrograde cholangiopancreatography findings.

During a 10-yr period starting January 1973, 123 patients with a carcinoma at the head of the pancreas underwent endoscopic retrograde cholangiopancreatography at our hospital. Analysis of their case histories revealed that the early complaints of pancreatic head carcinoma are rather nonspecific--sudden onset of diabetes mellitus (33.3%), weight loss (80.5%), tiredness and malaise (42.3%), change in bowel habits (41.5%), and upper abdominal discomfort (22.0%)--and that jaundice (88.6%) and classic pain (70.7%) are late symptoms. The diagnostic accuracy of endoscopic retrograde cholangiopancreatography (92.7%) was much higher than that of computed tomography (58.5%) and echography (54.4%). The patients were divided according to the maximal tumor diameter into three groups: group 1, tumor diameter ranging between 2.5 and 4.0 cm; group 2, tumor diameter ranging between 4.5 and 6.0 cm; and group 3, tumor diameter ranging between 7.0 and 15.0 cm. The tumor diameter did not correlate with the degree of differentiation. Extension of the tumor, vascular involvement, and metastases were evaluated for the several tumor diameters. The tumor was, in principle, operable in 77% of group 1 patients; in 24% of group 2 patients; and in 9% of group 3 patients. Tumors less than 3 cm in diameter were always resectable; tumors greater than 8 cm in diameter were seldom (9%) resectable. A curative resection was performed in 22.0% of the patients. The 4-yr survival of these patients was 44% as opposed to no survivors among the patients who had received only palliative or symptomatic treatment. During the decade, there was a tendency toward the diagnosis of smaller tumors (mean tumor diameter decreased from 9.0 +/- 1.7 to 5.4 +/- 2.8 cm) with a higher chance of resectability (from 25% to 44%).