Current trends in the management of carcinoma of the pancreatic head

J. M. Funovics, J. Karner, T. Pratschner, A. Fritsch

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Abstract

Between 1965 and 1987, 783 patients were treated for ductal adenocarcinoma. Of these, 59% had carcinoma of the pancretic head and 22% presented with carcinoma of the body or tail. In 19% of the cases the entire organ was involved. Two hundred and twenty-six patients (25.5%) underwent exploratory laparotomy; 420 patients (55%) had palliative operations, and 137 (18.5%) were resected for cure. In the past 3 years the resection rate increased from an original 18.5% to 28% (43 resective procedures in 153 patients). In 37 of the 137 patients (28%) surgery had to be extended to the portal vein, the superior mesenteric vein, the kidneys, adrenals, colon, stomach, liver and lymph nodes to ensure adequate radicality. At the same time in-hospital mortality (including deaths after extended procedures) dropped to 7%. Of the 137 patients resected for cure, 47% were alive at 1 year, 22% at 2 years, 12% at 3 years, 7% at 4 years, and 5% at 5 years. Mean survival time excluding in-hospital deaths was 18.65 months. In the first 15 months after surgery there was no difference in survival between standard resection and extended resections. Patients undergoing partial pancreaticoduodenectomy fared significantly better (p < 0.01; Mantel) than those who had total resections, in terms of both median survival (10.8 versus 5.4 months) and mean survival (19.0 versus 7.82 months). A comparison of curative resection and surgical palliation for medical reasons in patients with identical tumor stages (I and II) showed significant differences in median survival, which was 11.6 months for patients undergoing radical operations versus 5.4 months in the palliative group, and in mean survival (20.6 versus 7.9 months) (p < 0.05, Breslow; p < 0.001, Mantel-Cox). Improvemnts in long-term results, if any, can only be expected by combining surgery with adjuvant therapy.

Original languageEnglish
Pages (from-to)450-455
Number of pages6
JournalHepato-Gastroenterology
Volume36
Issue number6
Publication statusPublished - Dec 1 1989

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Keywords

  • carcinoma
  • current trends
  • pancreas
  • surgery
  • treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Funovics, J. M., Karner, J., Pratschner, T., & Fritsch, A. (1989). Current trends in the management of carcinoma of the pancreatic head. Hepato-Gastroenterology, 36(6), 450-455.