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. 1977 Dec;186(6):675–680. doi: 10.1097/00000658-197712000-00002

Total pancreatectomy for cancer. An appraisal of 65 cases.

I Ihse, P Lilja, B Arnesjö, S Bengmark
PMCID: PMC1396514  PMID: 603272

Abstract

Sixty-five patients operated with total pancreatectomy were reviewed with respect to factors influencing operative mortality and morbidity, long-term survival, and metabolic sequelae. The diagnoses were pancreatic cancer in 58 patients, periampullary cancer in three, cancer of the bile duct in two and leiomyosarcoma of the duodenum and cystadenocarcinoma of the pancreas in one patient, respectively. In nine of the 58 cases with cancer of the caput, the histological examination revealed multicentricity of the tumor. In 44%, there were signs of degeneration and fibrosis in the distal part of the gland. Hospital mortality was 23% for the entire series. After 1970 the hospital mortality was 17%, and among patients operated by senior surgeons especially trained in pancreatic surgery, the hospital mortality was 12% during the whole period. The peroperative bilirubin levels seemed to influence survival time. Among 24 patients operated before 1975 in whom the operating surgeon judged the operation as radical, a five year survival of 21% was recorded. In patients without detectable lymph node metastases, the mean survival time was 25 months. The postoperative exocrine insufficiency and diabetes were possible to control. A blood sugar level above 10 micromol/l was found to significantly decrease the frequency of hypoglycemic attacks. Total pancreatectomy appears to be the surgical procedure preferred when radical treatment is selected.

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Selected References

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

  1. Aston S. J., Longmire W. P., Jr Pancreaticoduodenal resection. Twenty years' experience. Arch Surg. 1973 Jun;106(6):813–817. doi: 10.1001/archsurg.1973.01350180047015. [DOI] [PubMed] [Google Scholar]
  2. Barnes A. J., Bloom S. R. Pancreatectomised man: A model for diabetes without glucagon. Lancet. 1976 Jan 31;1(7953):219–221. doi: 10.1016/s0140-6736(76)91339-8. [DOI] [PubMed] [Google Scholar]
  3. Bloom P., Steer M. L. Pancreatoduodenectomy. Results when the operation is performed infrequently. Arch Surg. 1975 Dec;110(12):1455–1457. doi: 10.1001/archsurg.1975.01360180025005. [DOI] [PubMed] [Google Scholar]
  4. Castellanos J., Manifacio G., Lillehei R. C., Shatney C. H. Total pancreatectomy for ductal carcinoma of the head of the pancreas: current status. Am J Surg. 1976 May;131(5):595–598. doi: 10.1016/0002-9610(76)90020-9. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Douglass H. O., Jr, Holyoke E. D. Pancreatic cancer. Initial treatment as the determinant of survival. JAMA. 1974 Aug 12;229(7):793–797. doi: 10.1001/jama.229.7.793. [DOI] [PubMed] [Google Scholar]
  7. Fish J. C., Smith L. B., Williams R. D. Digestive function after radical pancreaticoduodenectomy. Am J Surg. 1969 Jan;117(1):40–45. doi: 10.1016/0002-9610(69)90283-9. [DOI] [PubMed] [Google Scholar]
  8. Fortner J. G. Regional resection of cancer of the pancreas: a new surgical approach. Surgery. 1973 Feb;73(2):307–320. [PubMed] [Google Scholar]
  9. Gilsdorf R. B., Spanos P. Factors influencing morbidity and mortality in pancreaticoduodenectomy. Ann Surg. 1973 Mar;177(3):332–337. doi: 10.1097/00000658-197303000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. 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]
  11. LUNDH G. Pancreatic exocrine function in neoplastic and inflammatory disease; a simple and reliable new test. Gastroenterology. 1962 Mar;42:275–280. [PubMed] [Google Scholar]
  12. MONGE J. J., JUDD E. S., GAGE R. P. RADICAL PANCREATODUODENECTOMY: A 22-YEAR EXPERIENCE WITH THE COMPLICATIONS, MORTALITY RATE, AND SURVIVAL RATE. Ann Surg. 1964 Oct;160:711–722. doi: 10.1097/00000658-196410000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Miyata M., Takao T., Uozumi T., Okamoto E., Manabe H. Insulin secretion after pancreatoduodenectomy. Ann Surg. 1974 Apr;179(4):494–498. doi: 10.1097/00000658-197404000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Norton L., Eiseman B. Replacement of portal vein during pancreatectomy for carcinoma. Surgery. 1975 Feb;77(2):280–284. [PubMed] [Google Scholar]
  15. Pairent F. W., Howard J. M. Pancreatic exocrine insufficiency. IV. The enzyme content of commercial pancreatic supplements. Arch Surg. 1975 Jun;110(6):739–741. doi: 10.1001/archsurg.1975.01360120057010. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. ReMine W. H., Priestley J. T., Judd E. S., King J. N. Total pancreatectomy. Ann Surg. 1970 Oct;172(4):595–604. doi: 10.1097/00000658-197010000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Richards A. B., Sosin H. Cancer of the pancreas: the value of radical and palliative surgery. Ann Surg. 1973 Mar;177(3):325–331. doi: 10.1097/00000658-197303000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Shizgal H. M., Spanier A. H., Kurtz R. S. Effect of parenteral nutrition on body composition in the critically ill patient. Am J Surg. 1976 Feb;131(2):156–161. doi: 10.1016/0002-9610(76)90089-1. [DOI] [PubMed] [Google Scholar]
  20. Smith R. Progress in the surgical treatment of pancreatic disease. Am J Surg. 1973 Feb;125(2):143–153. doi: 10.1016/0002-9610(73)90019-6. [DOI] [PubMed] [Google Scholar]
  21. Wise L., Pizzimbono C., Dehner L. P. Periampullary cancer. A clinicopathologic study of sixty-two patients. Am J Surg. 1976 Feb;131(2):141–148. doi: 10.1016/0002-9610(76)90087-8. [DOI] [PubMed] [Google Scholar]

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