Disappointments in the Management of Patients With Malignancy of Pancreas, Duodenum, and Common Bile Duct

Only 8% of cancers of the pancreas, duodenum, and common bile ducts, in patients admitted over a 14-year period, qualified for curative resections. To date, among 275 cases, there is but one five-year survivor. In spite of these disappointments, a nihilistic approach to pancreaticoduodenal malignancy is not warranted. Patients receiving palliative procedures survived longer than those without surgery, and pancreaticoduodenectomy generally afforded a longer survival than patients undergoing palliative procedures. Among the patients with resectable lesions of the ampulla of Vater, there were no postoperative deaths even though all but two were in the seventh decade. These patients represent survivals so far from 9 to 74 months. The increasing incidence of cancer of the pancreas makes apparent an increased need for the training of the surgeon well versed in the performance of pancreatic resection.