Pancreaticoduodenectomy

Whipple and colleagues first described pancreaticoduodenectomy in 1935. More than 70 years later, this procedure remains the mainstay of curative treatment for pancreatic cancer. Nevertheless, 80% to 95% of tumors are unresectable at diagnosis because of local or regional extension or metastatic spread. Moreover, of the 5% to 20% of patients with resectable disease, obtaining surgical margins that are free of disease is possible for only 16% to 30%. Unfortunately, the median survival times for patients with disease-positive margins after surgery are similar to those for patients treated with chemoradiation therapy alone, (9 to 11 months). Accurate preoperative radiographic assessment of resectability and use of objective definitions of resectability are critical for avoiding incomplete resections.

 

Lesions of the pancreatic body and tail often manifest with signs and symptoms referable to invasion of surrounding structures, and most are inoperable because of arterial encasement or distant metastasis. In contrast, tumors arising in the pancreatic head often produce painless jaundice and symptoms referable to exocrine insufficiency; these symptoms more often lead to the disease being diagnosed when it is still resectable. The best surgical series report 5-year survival rates of 20% to 25%.The use of modern surgical techniques by experienced surgeons can produce operative mortality rates of less than 5% for patients who undergo pancreaticoduodenectomy.