Surgical treatment of pancreatic carcinoma

We reviewed 75 patients operated on for carcinoma of the pancreas during the period 1973 to 1978. The role of surgery was examined in terms of contributing toward diagnosis, palliation, and cure. Computerized tomography, ultrasonography, upper gastrointestinal series, and arteriography were used to determine the presence or absence of a pancreatic mass. Arteriography and CT scanning were very helpful. Histologic confirmation was most often provided in conjunction with celiotomy. Endoscopy with cytology and percutaneous needle biopsy was quite specific but was rarely done. Palliative decompression of the biliary tree was done in 63% and biopsy alone in 21%, with a collective morbidity of 20% and a mortality of 3%. Potentially curative resection was done in only 8% with no immediate postoperative deaths. Although pancreaticoduodenectomy will continue to offer the only chance of cure in small numbers of patients, it is evident the present role of surgery is largely for diagnosis and palliation. In view of the mortality and morbidity of operation, increased emphasis should be placed on noninvasive diagnostic tests (CT scan, endoscopy with cytology, and direct needle biopsy). The future role of surgical reduction of the tumor mass in conjunction with adjuvant therapy is at present ill defined.