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. 1995 Mar;221(3):241–248. doi: 10.1097/00000658-199503000-00005

The Whipple resection for cancer in U.S. Department of Veterans Affairs Hospitals.

T P Wade 1, A G el-Ghazzawy 1, K S Virgo 1, F E Johnson 1
PMCID: PMC1234565  PMID: 7717777

Abstract

OBJECTIVE: The authors compiled the results after Whipple resection for cancer from a large U.S. national hospital system. METHODS: Computerized hospital and death benefits records for patients treated with Whipple resection for cancer from 1987 to 1991 in U.S. Department of Veterans Affairs hospitals were analyzed, excluding lymphomas and neuroendocrine tumors. Institutional tumor registrar reports allowed TNM staging in 45% of these cancers. RESULTS: Whipple resections were performed in 252 patients with pancreatic cancer and 117 with other periampullary cancers. Complications occurred in 37%, and 30-day operative mortality was 8%. Postoperative sepsis was associated with a higher operative mortality rate. In patients with staged tumors, 5-year survivors were found only in those without lymph node involvement. CONCLUSIONS: Whipple resection can cure cancer in or near the head of the pancreas when lymph nodes are not invaded by tumor. Complications occur in nearly 40% of patients, whereas operative mortality rate is related to the average age of the patient population.

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Selected References

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  1. Baumel H., Huguier M., Manderscheid J. C., Fabre J. M., Houry S., Fagot H. Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery. Br J Surg. 1994 Jan;81(1):102–107. doi: 10.1002/bjs.1800810138. [DOI] [PubMed] [Google Scholar]
  2. Boyle C. A., Decouflé P. National sources of vital status information: extent of coverage and possible selectivity in reporting. Am J Epidemiol. 1990 Jan;131(1):160–168. doi: 10.1093/oxfordjournals.aje.a115470. [DOI] [PubMed] [Google Scholar]
  3. Braasch J. W., Deziel D. J., Rossi R. L., Watkins E., Jr, Winter P. F. Pyloric and gastric preserving pancreatic resection. Experience with 87 patients. Ann Surg. 1986 Oct;204(4):411–418. doi: 10.1097/00000658-198610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brooks J. R., Culebras J. M. Cancer of the pancreas. Palliative operation, Whipple procedure, or total pancreatectomy? Am J Surg. 1976 Apr;131(4):516–520. doi: 10.1016/0002-9610(76)90167-7. [DOI] [PubMed] [Google Scholar]
  5. Cameron J. L., Pitt H. A., Yeo C. J., Lillemoe K. D., Kaufman H. S., Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993 May;217(5):430–438. doi: 10.1097/00000658-199305010-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Crist D. W., Cameron J. L. Current status of pancreaticoduodenectomy for periampullary carcinoma. Hepatogastroenterology. 1989 Dec;36(6):478–485. [PubMed] [Google Scholar]
  7. Edge S. B., Schmieg R. E., Jr, Rosenlof L. K., Wilhelm M. C. Pancreas cancer resection outcome in American University centers in 1989-1990. Cancer. 1993 Jun 1;71(11):3502–3508. doi: 10.1002/1097-0142(19930601)71:11<3502::aid-cncr2820711107>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  8. Grace P. A., Pitt H. A., Tompkins R. K., DenBesten L., Longmire W. P., Jr Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg. 1986 Jan;151(1):141–149. doi: 10.1016/0002-9610(86)90024-3. [DOI] [PubMed] [Google Scholar]
  9. Hatfield A. R., Tobias R., Terblanche J., Girdwood A. H., Fataar S., Harries-Jones R., Kernoff L., Marks I. N. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet. 1982 Oct 23;2(8304):896–899. doi: 10.1016/s0140-6736(82)90866-2. [DOI] [PubMed] [Google Scholar]
  10. Horgan C., Taylor A., Wilensky G. Aging veterans: will they overwhelm the VA medical care system? Health Aff (Millwood) 1983 Fall;2(3):77–86. doi: 10.1377/hlthaff.2.3.77. [DOI] [PubMed] [Google Scholar]
  11. Klinkenbijl J. H., van der Schelling G. P., Hop W. C., van Pel R., Bruining H. A., Jeekel J. The advantages of pylorus-preserving pancreatoduodenectomy in malignant disease of the pancreas and periampullary region. Ann Surg. 1992 Aug;216(2):142–145. doi: 10.1097/00000658-199208000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. McPherson G. A., Benjamin I. S., Hodgson H. J., Bowley N. B., Allison D. J., Blumgart L. H. Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg. 1984 May;71(5):371–375. doi: 10.1002/bjs.1800710522. [DOI] [PubMed] [Google Scholar]
  13. Miedema B. W., Sarr M. G., van Heerden J. A., Nagorney D. M., McIlrath D. C., Ilstrup D. Complications following pancreaticoduodenectomy. Current management. Arch Surg. 1992 Aug;127(8):945–950. doi: 10.1001/archsurg.1992.01420080079012. [DOI] [PubMed] [Google Scholar]
  14. Pellegrini C. A., Heck C. F., Raper S., Way L. W. An analysis of the reduced morbidity and mortality rates after pancreaticoduodenectomy. Arch Surg. 1989 Jul;124(7):778–781. doi: 10.1001/archsurg.1989.01410070028006. [DOI] [PubMed] [Google Scholar]
  15. Pitt H. A., Gomes A. S., Lois J. F., Mann L. L., Deutsch L. S., Longmire W. P., Jr Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg. 1985 May;201(5):545–553. doi: 10.1097/00000658-198505000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Salas Coll C. A. Esofagitis de reflujo. G E N. 1994 Jul-Sep;48(3):179–189. [PubMed] [Google Scholar]
  17. Swope T. J., Wade T. P., Neuberger T. J., Virgo K. S., Johnson F. E. A reappraisal of total pancreatectomy for pancreatic cancer: results from U.S. Veterans Affairs hospitals, 1987-1991. Am J Surg. 1994 Dec;168(6):582–586. doi: 10.1016/s0002-9610(05)80126-6. [DOI] [PubMed] [Google Scholar]
  18. Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978 Jun;146(6):959–962. [PubMed] [Google Scholar]
  19. Trede M., Schwall G., Saeger H. D. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990 Apr;211(4):447–458. doi: 10.1097/00000658-199004000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Wade T. P., Radford D. M., Virgo K. S., Johnson F. E. Complications and outcomes in the treatment of pancreatic adenocarcinoma in the United States veteran. J Am Coll Surg. 1994 Jul;179(1):38–48. [PubMed] [Google Scholar]
  21. Warren K. W., Choe D. S., Plaza J., Relihan M. Results of radical resection for periampullary cancer. Ann Surg. 1975 May;181(5):534–540. doi: 10.1097/00000658-197505000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Whipple A. O. Pancreaticoduodenectomy for Islet Carcinoma : A Five-Year Follow-Up. Ann Surg. 1945 Jun;121(6):847–852. doi: 10.1097/00000658-194506000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Whipple A. O., Parsons W. B., Mullins C. R. TREATMENT OF CARCINOMA OF THE AMPULLA OF VATER. Ann Surg. 1935 Oct;102(4):763–779. doi: 10.1097/00000658-193510000-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]

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