[Personal experience in surgical resection of pancreatic carcinoma]. FT Esperienza personale nella chirurgia resettiva del carcinoma pancreatico

The period 1981-1993, 124 patients underwent resection for pancreatic cancer; they represented 30.8% of all patients observed in that period. Surgical procedures were a pancreatoduodenectomy (PD) in 100 cases, a total pancreatectomy (TP) in 3 cases and a distal pancreatectomy in 21 cases. PD was performed by the injection of Neoprene into the residual pancreatic stump, rather than of pancreatojejunal anastomosis; in 37 cases a pylorus-preserving PD was performed. Adjuvant treatments were given in addition to resection in 75 patients: 47 underwent intraoperative radiation therapy, following a PD in 41 cases, a TP in 1 case and a distal pancreatectomy in 5 cases. Overall operative mortality was 2.4%, overall morbidity 26.6%. In the 103 patients undergoing PD or TP mortality was 2.9% and morbidity 29.1%. Postoperative diabetes occurred in 12.8% of patients undergoing PD with Neoprene injection. Overall median survival was 16 months. Survival was significantly related to UICC staging distribution, to the radical nature of the operation or to adjuvant treatments. No relationship was found between survival and the type of resection (PD versus distal pancreatectomy) or the pylorus preservation. Pancreatic resection, whenever technically possible, represents the treatment of choice of localised pancreatic cancer, in association with adjuvant treatments.