Study of 170 patients with carcinoma of the pancreas suggested that initial pancreatoduodenectomy, when the tumor had arisen in the head of the pancreas or periampullary region, resulted in greater relief of symptoms than palliative bypasses. Staged resections offered no greater benefit than biliary bypasses, except to occasional patients with polypoid periampullary carcinomas. After biliary diversion, the frequent need for gastroenterostomy within three months suggested that gastric stasis often antedated the first operation, and it could have been detected by preoperative roentgenograms of the upper gastrointestinal tract.
(JAMA 229:793-797, 1974)
Douglass HO, Holyoke ED. Pancreatic Cancer: Initial Treatment as the Determinant of Survival. JAMA. 1974;229(7):793–797. doi:10.1001/jama.1974.03230450027019
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