Immunologic function in patients with carcinoma of the pancreas.

The immune fuction of 41 patients with duct cell adenocarcinoma of the pancreas or carcinoma of the periampullary region was studied by skin testing with 2,4-dinitrocholorobenzene and common microbial antigens, in vitro lymphocyte reactivity to mitogens, T-lymphocyte and B-lymphocyte cell counts and measurements of complement levels. Results show that a great proportion of patients had depressed immune function. Depression is particularly severe in lymphocyte reactivity. Positive response to skin tests with a microbial antigen carries a slightly better prognosis. The complement level is usually normal or elevated. Correlation between immune function, prognosis and tumor resectability in individual patients is generally poor.

Major hepatic resection for neoplasia: personal experience in 108 patients.

One hundred eight patients have undergone major hepatic resection by the senior author during the eight year period April 1970 to April 1978. Primary liver cancer was present in 36; metastatic colorectal cancer in 25, miscellaneous metastatic cancers in 15, hepatoblastoma in 5, gallbladder cancer in 4, and bile duct cancer in 3. Benign tumors, principally giant hemangioma, were resected in 20 additional patients. The 30 day operative mortality rate was 9% overall. Prior to 1975, 41 of the resections were done using the vascular isolation perfusion technique. The operative mortality rate of 17% for this technique is a reflection of early experience and the advanced stage of disease of many patients. The operative mortality for the standard resection has been only 4%. Subphrenic abscess has developed in only 13% of patients during the past three years. Postoperative hospitalization has been shortened, being a median of 13 days. The resectability rate for malignant disease was 33%. Forty-six percent of the resections were performed with curative intent. Fifty-four per cent were palliative, performed in individuals with regional spread or distant metastasis. After curative surgery, three year survival was 88% for individuals with primary liver cancer and 72% with metastatic colorectal cancer. After palliative resection, the rates were 31 and 0%, respectively. The three year survival rate is 46% overall, being 81% for the curative resection group and 18% for the palliative group. Tumor markers proved useful in monitoring patients after hepatic resection.