Pancreaticoduodenectomy for pancreatic and duodenal malignancy

ABSTRACT

Radical resection of malignant tumors of pancreatic head, distal common bile duct, periampullary region and duodenum was performed in 11 patients with a mean age 51.4 years. More than half of the patients had been jaundiced at the time of operation. Preoperative stenting of the CBD helped to improve the jaundice prior to resection. Formal Whipple pancreaticoduodenectomy was the standard procedure in 8 patients and pylorus-preserving pancreaticoduodenectomy was done in 3 patients. Five patients had carcinoma of the pancreatic head proper, 3 patients had periampullary carcinoma, 2 patients had carcinoma of the distal CBD, and one patient had lymphoblastic lymphoma of the second part of the duodenum. Pancreatic fistula occurred in 2 patients, one of whom died because of associated uncontrollable infection and nutritional depletion, and the other one closed spontaneously. Minor septic complications developed in 2 patients. Long-term follow up showed 5 patients who are alive and free of recurrence. Certain detailed meticulous steps in the technique of reconstruction and pancreaticojejunal anastomosis helped to improve the results. Pancreaticoduodenectomy is considered to have an acceptable morbidity and mortality and the long-term survival is possible even for patients with cancer head proper of pancreas