[Clinical symptoms in cancer of the exocrine pancreas in peri-ampullary region. Old and new knowledge from the analysis of a surgical patient sample].

A retrospective analysis of presenting clinical symptoms was performed in 584 patients who were operated on at a surgical university hospital during the last two decades because of carcinoma of the exocrine pancreas or the periampullary region. Patients with carcinoma of the pancreatic head primarily presented with jaundice, those with localisation of the tumour in the pancreatic body and tail with pain. In contrast to the common opinion ampullary carcinomas produced jaundice only in 70% of patients. In our series ampullary carcinomas did not present clinical symptoms at an earlier stage than pancreatic head tumours as it is commonly speculated. At the time of surgery carcinomas of the ampulla and the pancreatic head were found to be in equivalent stages. A NIDDM was significantly associated with carcinomas of the pancreatic body. Diabetes mellitus is more likely a result of carcinomatous destruction of the pancreas rather than a precancerosis. Almost all periampullary tumours could be resected while the resection rate was only 41% in case of exocrine pancreatic tumours. Pancreatic carcinomas which presented with upper abdominal pain, back pain, weight loss, inappentence, and diarrhoea were significantly more often irresectable. Jaundice, however, was more frequent in patients with resectable tumours. Back pain is probably caused by infiltration of the retroperitoneum and the aortic plexus and thus represents the clinical sign of an often occult retroperitoneal tumour spread. The precise knowledge of the presenting symptoms in cancer of the pancreas and ampulla is of primary importance because diagnostic procedures only commences after onset of symptoms and no possibilities of an effective screening can be envisaged.