One hundred eighty-five patients with periampullary carcinoma seen at the UCLA Hospital during the past 20 years were reviewed. Pancreaticoduodenectomy was performed in 39 with carcinoma of the head of the pancreas, in 16 with carcinoma of the ampulla of Vater, and in 10 with cancer of the common bile duct. Survivors, up to 13 years postoperatively, are discussed in terms of the primary site of tumor, those with lesions of the ampulla of Vater and the common bile duct showing the best results. Data concerning operative and late deaths as well as morbidity factors are presented and discussed. Reduction of the operative mortality to 5.1% during the past 9½ years, the extended length of survival in some patients, and the occasional apparent cure justify continued use of this aggressive approach. The morbidity and mortality of patients who underwent palliative procedures for disease beyond the limits of resectability are compared with those who had pancreaticoduodenal resection. Biliary bypass is recommended, when feasible, in advanced disease when pancreaticoduodenectomy is precluded.
Aston SJ, Longmire WP. Pancreaticoduodenal ResectionTwenty Years' Experience. Arch Surg. 1973;106(6):813-817. doi:10.1001/archsurg.1973.01350180047015