Over a 21 year period, 245 cases of
cancer of the pancreas were operated upon and followed-up at UCLA Hospital. A further 34 cases of periampullary
tumor were treated by partial or total
pancreatectomy. Apparent clearance of
tumors at the time of
pancreaticoduodenectomy that was confirmed by subsequent histopathology resulted in a patient survival time of 20.3 months as compared with a figure of 12.9 months when the pathological examination revealed
tumor in a
resection margin, although the surgeon believed that excision had been complete at the time of operation. Frozen section examination of
resection margins is therefore mandatory. The result of performing a
pancreaticoduodenectomy in which
tumor was seen to be left behind was a survival time of only 6.8 months, which is similar to the survival time of 6.2 months following a palliative biliary bypass.
Pancreaticoduodenectomy in patients over the age of 70 resulted in an average survival of only 7.6 months. Of patients having a palliative biliary bypass alone, 13% required subsequent reoperation to bypass distressing
duodenal obstruction. A duodenal bypass should therefore be a routine concomitant of a biliary bypass. Total
pancreatectomy with duodenectomy for
pancreatic cancer gave an increased average survival of 26 months, and it is likely that the frequency of performance of this operation will increase.