Pancreatoduodenectomy for Periampullary Carcinoma: Experience with 320 Cases

Abstract

From 1962 to 1994, 1200 patients with periampullary carcinoma had laparotomy in our department. Of these cases, 320 underwent pancreatoduodenectomy (PD); the resection rate was 25.8%. Hospital mortality was 23 cases (7.19%), and hospital morbidity was 69 cases (21.9%). The 320 PD, 214 were men and 106 women, ranging in age from 26 to 73 years, with a median of 52.9 years. The lesions of the 320 cases were carcinoma in the head of pancreas (81 cases), in the common bile duct (85), in the ampulla of Vater (104), and in the duodenum (50). The method of resection we preferred is to follow the order of gallbladder, bile duct, stomach, proximal jejunum, and duodenum initially and leave the pancreas until last; this method provides excellent exposure of the uncinate process and controls bleeding easily. Gastrojejunual anastomosis was the retrocolic procedure. The end of the jejunum is brought into the upper abdomen in a retrocolic position, but anterior to the mesenteric vessels. Pancreatic fistula is a common and serious complication following PD. From 1962 to 1970, 43PDs with end-to-side anastomosis without pancreatic drainage were performed; the fistula occurred in 10 patients and 6 died; thus, we changed the method to end-to-end anastomosis between the pancreas and jejunum, and in 14 patients with internal drainage by use of a short tube, fistula occurred in 2 cases. We then changed to a long catheter for external drainage for 237 cases, and the fistula occurred only in 3 cases. Our data show that the postoperative survival rate is poor for pancreatic carcinoma. The 1-year survival rate is no more than 50%, and the 3-year rate is only 13.58%. However, for carcinoma of the ampulla of Vater and common bile duct, the result is better; the 5-year survival rate for carcinoma of the ampulla of Vater is 41.54%, which is the best result.