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Commentary
July 2002

Pancreatoduodenectomy for Pancreatic AdenocarcinomaTriumph, Triumphalism, or Transition?

Arch Surg. 2002;137(7):771-773. doi:10.1001/archsurg.137.7.771

AS SURGEONS, we can be justifiably proud of the truly remarkable reductions in operative mortality rates following pancreatoduodenectomy for pancreatic adenocarcinoma that have been achieved within the past decade. Thirty-day mortality rates of 5%, or even less, are commonly reported today.16 Few would deny that these rates represent a technical triumph when compared with the 20% to 30% operative mortality rates that were experienced only a generation ago. The establishment of high-volume pancreatic surgical centers has been an important part of this success.710 Credit for this dramatic decrease in surgical mortality cannot be claimed solely by the surgical profession, however, as other significant advances, such as improvements in perioperative care and imaging techniques, occurred during this same period. Nevertheless, it can no longer be persuasively argued, as it was in the 1970s by Crile11 and others,12 that because the operative mortality for pancreatoduodenectomy exceeded the 5-year survival rate, bypass is preferable to resection for patients with adenocarcinoma of the head of the pancreas.

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