Total Pancreatectomy and Subtotal Duodenopancreatectomy for the Management of Carcinoma of the Head of the Pancreas: An Institutional Experience and Evolving Trends

This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Since 1973, total pancreatectomy has been the treatment of choice. Our policy changed after a review of 47 consecutive total pancreatectomies in 1986, which showed no benefit. We reintroduced the Whipple procedure as our standard operation, and for the following 41 patients, the Whipple procedure was performed 19 times; a total pancreatectomy was performed 22 times, however, because of positive resection margins or a friable pancreatic remnant. After total pancreatectomy, the 5-year survival rate was 7.8%. For lymph node-negative patients, the 1-, 3-, and 5-year survival rates were 54%, 24%, and 15%, respectively. For lymph node-positive patients, the 1- and 3-year survival rates were 46% and 4%, respectively, and there were no survivors at 54 months. This difference was not statistically significant. After the Whipple procedure, the 5-year survival rate was 12.5%. For lymph node-negative patients, the 1-, 3-, and 5-year survival rates were 50%, 59%, and 25%. For lymph node-positive patients, the 1-year survival rate was 21%; this difference was significant (P = .007). This study highlights the fact that extended radical surgery does not improve overall survival, but stages 2 and 3 disease (Hermreck classification) was associated with prolonged survival.