Diagnosis and surgical treatment of pancreatic carcinoma.

The aim of study was presentation of our experiences in diagnosis and treatment in pancreatic carcinoma in confrontation with current opinions. Between 1984-1995 at our Department was treated 211 patients with carcinoma of exocrine part of the pancreas. It were 137 male and 74 female with mean age 58.9 years. In 151 cases (70.5%) primary seat of tumour was located in the head and in 60 cases (29.5.1%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigation Diagnostic accuracy of X-ray investigations was as follow: Ultrasonography-86%, CT-scan-91%, ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnosis improved detectability of resectionable carcinomas in the last past years. Among 211 patients, 199 underwent surgery. The procedures depended on the localisation and grade of advance of the tumours. UICC classification of pancreatic tumours, pTNM (4th edition 1987) was used. Only in 21 patients (9.9%) (tumours pT1a-b N0M0) was possible to perform radical operation (resection of the pancreas). However in 107 patients (50.7%) were done only paliative procedures (pT2N1M0). In 83 patients (39.3%) only laparotomy and biopsy were performed (tumours pT2N1M1). The study shows that although improvement of the diagnostic methods tumors of the pancreas are diagnosed in stages making unable the radical procedures and only about 10% of carcinomas are resectable. It is relevant with non-characteristic picture of the diseases in its early stages.