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. 1979 Sep;190(3):373–381. doi: 10.1097/00000658-197909000-00013

Histopathology in the evaluation of total pancreatectomy for ductal carcinoma.

A F Tryka, J R Brooks
PMCID: PMC1344674  PMID: 485612

Abstract

Whipple resections for pancreatic head carcinoma are often inadequate because tumor is left behind in the body and tail. Thirty-six patients have undergone total pancreatectomy for various conditions, of which 25 have undergone total pancreatectomy, for ductal carcinoma. Thirty-seven per cent of these 25 patients have shown histologic evidence that a Whipple resection would not have adequately removed tumor-bearing pancreatic tissue. Three patients had carcinoma spreading up and along the common bile duct from a primary ductal carcinoma in the head of the pancreas. Four patients had tumor infiltrating in continuity into the pancreatic body and tail at a distance from the palpable tumore in the head well to the left of a Whipple transection site. Five patients had widespread multifocal autonomous tumor involving other areas in the gland but with tumor palpable only in the head of the pancreas. Three patients (12%) died postoperatively. The two year survival rate is 32%, and the five year survival, 19%. Histological factors affecting the survival prognosis include 1) positive nodes, 2) tumor extension up the common duct, and 3) intrapancreatic extension and multicentricity of tumor mandating total pancreatectomy for hope of cure in at least 38% of cases.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. 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]
  2. Collins J. J., Jr, Craighead J. E., Brooks J. R. Rationale for total pancreatectomy for carcinoma of the pancreatic head. N Engl J Med. 1966 Mar 17;274(11):599–602. doi: 10.1056/NEJM196603172741103. [DOI] [PubMed] [Google Scholar]
  3. Crane J. M., Gobbel W. G., Jr, Scott H. W., Jr Surgical experience with malignant tumors of the ampulla of vater and duodenum. Surg Gynecol Obstet. 1973 Dec;137(6):937–940. [PubMed] [Google Scholar]
  4. Cubilla A. L., Fitzgerald P. J. Morphological lesions associated with human primary invasive nonendocrine pancreas cancer. Cancer Res. 1976 Jul;36(7 Pt 2):2690–2698. [PubMed] [Google Scholar]
  5. Hermreck A. S., Thomas C. Y., 4th, Friesen S. R. Importance of pathologic staging in the surgical management of adenocarcinoma of the exocrine pancreas. Am J Surg. 1974 Jun;127(6):653–657. doi: 10.1016/0002-9610(74)90341-9. [DOI] [PubMed] [Google Scholar]
  6. Hicks R. E., Brooks J. R. Total pancreatectomy for ductal carcinoma. Surg Gynecol Obstet. 1971 Jul;133(1):16–20. [PubMed] [Google Scholar]
  7. Ihse I., Lilja P., Arnesjö B., Bengmark S. Total pancreatectomy for cancer. An appraisal of 65 cases. Ann Surg. 1977 Dec;186(6):675–680. doi: 10.1097/00000658-197712000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Levin B., ReMine W. H., Hermann R. E., Schein P. S., Cohn I., Jr Panel: cancer of the pancreas. Am J Surg. 1978 Feb;135(2):185–191. doi: 10.1016/0002-9610(78)90094-6. [DOI] [PubMed] [Google Scholar]
  9. MONGE J. J., DOCKERTY M. B., WOLLAEGER E. E., WAUGH J. M., PRIESTLEY J. T. CLINICOPATHOLOGIC OBSERVATIONS ON RADICAL PANCREATODUODENAL RESECTION FOR PERIPAPILLARY CARCINOMA. Surg Gynecol Obstet. 1964 Feb;118:275–283. [PubMed] [Google Scholar]
  10. PORTER M. R. Carcinoma of the pancreatico-duodenal area; operability and choice of procedure. Ann Surg. 1958 Oct;148(4):711–724. doi: 10.1097/00000658-195810000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pliam M. B., ReMine W. H. Further evaluation of total pancreatectomy. Arch Surg. 1975 May;110(5):506–512. doi: 10.1001/archsurg.1975.01360110052010. [DOI] [PubMed] [Google Scholar]
  12. ROSS D. E. Cancer of the pancreas; a plea for total pancreatectomy. Am J Surg. 1954 Jan;87(1):20–33. doi: 10.1016/0002-9610(54)90038-0. [DOI] [PubMed] [Google Scholar]
  13. Warren K. W., Hardy K. J. Cystadenocarcinoma of the pancreas. Surg Gynecol Obstet. 1968 Oct;127(4):734–736. [PubMed] [Google Scholar]

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