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. 1988 Nov;208(5):541–553. doi: 10.1097/00000658-198811000-00001

Pancreatic cancer in 1988. Possibilities and probabilities.

A L Warshaw 1, R S Swanson 1
PMCID: PMC1493791  PMID: 2461172

Abstract

Pancreatic adenocarcinoma is increasing in frequency, generally grows without symptoms until late in its natural history, and presents many discouraging unresolved problems in management. This review analyzes the status of current modalities of diagnosis, staging, and treatment. The limitations of those methods are defined, and possible improvements and new directions are suggested. A strategy for a rational and humane approach to pancreatic cancer is developed with the goal of maximizing quality as well as quantity of life.

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Selected References

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  1. Abe M., Takahashi M. Intraoperative radiotherapy: the Japanese experience. Int J Radiat Oncol Biol Phys. 1981 Jul;7(7):863–868. doi: 10.1016/0360-3016(81)90001-8. [DOI] [PubMed] [Google Scholar]
  2. Ackerman N. B., Aust J. C., Bredenberg C. E., Hanson V. A., Jr, Rogers L. S. Problems in differentiating between pancreatic lymphoma and anaplastic carcinoma and their management. Ann Surg. 1976 Dec;184(6):705–708. doi: 10.1097/00000658-197612000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Andrén-Sandberg A., Ihse I. Factors influencing survival after total pancreatectomy in patients with pancreatic cancer. Ann Surg. 1983 Nov;198(5):605–610. doi: 10.1097/00000658-198311000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Aranha G. V., Prinz R. A., Freeark R. J., Greenlee H. B. The spectrum of biliary tract obstruction from chronic pancreatitis. Arch Surg. 1984 May;119(5):595–600. doi: 10.1001/archsurg.1984.01390170091018. [DOI] [PubMed] [Google Scholar]
  5. Bornman P. C., Harries-Jones E. P., Tobias R., Van Stiegmann G., Terblanche J. Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas. Lancet. 1986 Jan 11;1(8472):69–71. doi: 10.1016/s0140-6736(86)90719-1. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. Brooks D. C., Osteen R. T., Gray E. B., Jr, Steele G. D., Jr, Wilson R. E. Evaluation of palliative procedures for pancreatic cancer. Am J Surg. 1981 Apr;141(4):430–433. doi: 10.1016/0002-9610(81)90135-5. [DOI] [PubMed] [Google Scholar]
  8. Brown P. C., Hart M. J., White T. T. Pancreatic lymphoma, diagnosis and management. Int J Pancreatol. 1987 Apr;2(2):93–99. doi: 10.1007/BF03015002. [DOI] [PubMed] [Google Scholar]
  9. Bukowski R. M., Balcerzak S. P., O'Bryan R. M., Bonnet J. D., Chen T. T. Randomized trial of 5-fluorouracil and mitomycin C with or without streptozotocin for advanced pancreatic cancer. A Southwest Oncology Group study. Cancer. 1983 Nov 1;52(9):1577–1582. doi: 10.1002/1097-0142(19831101)52:9<1577::aid-cncr2820520906>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  10. Campanale R. P., 2nd, Frey C. F., Farias L. R., Twomey P. L., Guernsey J. M., Keehn R., Higgins G. Reliability and sensitivity of frozen-section pancreatic biopsy. Arch Surg. 1985 Mar;120(3):283–288. doi: 10.1001/archsurg.1985.01390270023005. [DOI] [PubMed] [Google Scholar]
  11. Cohen J. R., Kuchta N., Geller N., Shires G. T., Dineen P. Pancreaticoduodenectomy. A 40-year experience. Ann Surg. 1982 May;195(5):608–617. doi: 10.1097/00000658-198205000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cohen L., Woodruff K. H., Hendrickson F. R., Kurup P. D., Mansell J., Awschalom M., Rosenberg I., Ten Haken R. K. Response of pancreatic cancer to local irradiation with high-energy neutrons. Cancer. 1985 Sep 15;56(6):1235–1241. doi: 10.1002/1097-0142(19850915)56:6<1235::aid-cncr2820560602>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  13. Connolly M. M., Dawson P. J., Michelassi F., Moossa A. R., Lowenstein F. Survival in 1001 patients with carcinoma of the pancreas. Ann Surg. 1987 Sep;206(3):366–373. doi: 10.1097/00000658-198709000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Connolly M. M., Dawson P. J., Michelassi F., Moossa A. R., Lowenstein F. Survival in 1001 patients with carcinoma of the pancreas. Ann Surg. 1987 Sep;206(3):366–373. doi: 10.1097/00000658-198709000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Cotton P. B. Endoscopic methods for relief of malignant obstructive jaundice. World J Surg. 1984 Dec;8(6):854–861. doi: 10.1007/BF01656025. [DOI] [PubMed] [Google Scholar]
  16. Crile G., Jr The advantages of bypass operations over radical pancreatoduodenectomy in the treatment of pancreatic carcinoma. Surg Gynecol Obstet. 1970 Jun;130(6):1049–1053. [PubMed] [Google Scholar]
  17. Crist D. W., Sitzmann J. V., Cameron J. L. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987 Sep;206(3):358–365. doi: 10.1097/00000658-198709000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Crowson M. C., Dorrell A., Rolfe E. B., Fielding J. W. A phase II study to evaluate tamoxifen in pancreatic adenocarcinoma. Eur J Surg Oncol. 1986 Dec;12(4):335–336. [PubMed] [Google Scholar]
  19. Cubilla A. L., Fitzgerald P. J., Fortner J. G. Pancreas cancer -- duct cell adenocarcinoma: survival in relation to site, size, stage and type of therapy. J Surg Oncol. 1978;10(6):465–482. doi: 10.1002/jso.2930100602. [DOI] [PubMed] [Google Scholar]
  20. Cuschieri A., Hall A. W., Clark J. Value of laparoscopy in the diagnosis and management of pancreatic carcinoma. Gut. 1978 Jul;19(7):672–677. doi: 10.1136/gut.19.7.672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Devereux D. F., Greco R. S. Biliary enteric bypass for malignant obstruction. Cancer. 1986 Aug 15;58(4):981–984. doi: 10.1002/1097-0142(19860815)58:4<981::aid-cncr2820580431>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  22. Dickey J. E., Haaga J. R., Stellato T. A., Schultz C. L., Hau T. Evaluation of computed tomography guided percutaneous biopsy of the pancreas. Surg Gynecol Obstet. 1986 Dec;163(6):497–503. [PubMed] [Google Scholar]
  23. Dobelbower R. R., Jr, Merrick H. W., 3rd, Ahuja R. K., Skeel R. T. 125I interstitial implant, precision high-dose external beam therapy, and 5-FU for unresectable adenocarcinoma of pancreas and extrahepatic biliary tree. Cancer. 1986 Nov 15;58(10):2185–2195. doi: 10.1002/1097-0142(19861115)58:10<2185::aid-cncr2820581004>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  24. Doberneck R. C., Berndt G. A. Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg. 1987 Jul;122(7):827–829. doi: 10.1001/archsurg.1987.01400190093020. [DOI] [PubMed] [Google Scholar]
  25. Douglass H. O., Jr Pancreatic cancer: nihilism is obsolete! Pancreas. 1987;2(2):230–232. doi: 10.1097/00006676-198703000-00017. [DOI] [PubMed] [Google Scholar]
  26. Dunn E. The impact of technology and improved perioperative management upon survival from carcinoma of the pancreas. Surg Gynecol Obstet. 1987 Mar;164(3):237–244. [PubMed] [Google Scholar]
  27. Edis A. J., Kiernan P. D., Taylor W. F. Attempted curative resection of ductal carcinoma of the pancreas: review of Mayo Clinic experience, 1951-1975. Mayo Clin Proc. 1980 Sep;55(9):531–536. [PubMed] [Google Scholar]
  28. Falk R. E., Moffat F. L., Lawler M., Heine J., Makowka L., Falk J. A. Combination therapy for resectable and unresectable adenocarcinoma of the pancreas. Cancer. 1986 Feb 1;57(3):685–688. doi: 10.1002/1097-0142(19860201)57:3<685::aid-cncr2820570348>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  29. Ferrucci J. T., Jr, Wittenberg J., Mueller P. R., Simeone J. F., Harbin W. P., Kirkpatrick R. H., Taft P. D. Diagnosis of abdominal malignancy by radiologic fine-needle aspiration biopsy. AJR Am J Roentgenol. 1980 Feb;134(2):323–330. doi: 10.2214/ajr.134.2.323. [DOI] [PubMed] [Google Scholar]
  30. Flanigan D. P., Kraft R. O. Continuing experience with palliative chemical splanchnicectomy. Arch Surg. 1978 Apr;113(4):509–511. doi: 10.1001/archsurg.1978.01370160167029. [DOI] [PubMed] [Google Scholar]
  31. Forrest J. F., Longmire W. P., Jr Carcinoma of the pancreas and periampullary region. Ann Surg. 1979 Feb;189(2):129–138. doi: 10.1097/00000658-197902000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Fortner J. G. Regional pancreatectomy for cancer of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg. 1984 Apr;199(4):418–425. doi: 10.1097/00000658-198404000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Freeny P. C., Ball T. J. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) in the evaluation of suspected pancreatic carcinoma: diagnostic limitations and contemporary roles. Cancer. 1981 Mar 15;47(6 Suppl):1666–1678. doi: 10.1002/1097-0142(19810315)47:6+<1666::aid-cncr2820471435>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  34. Freeny P. C., Marks W. M., Ryan J. A., Traverso L. W. Pancreatic ductal adenocarcinoma: diagnosis and staging with dynamic CT. Radiology. 1988 Jan;166(1 Pt 1):125–133. doi: 10.1148/radiology.166.1.2827228. [DOI] [PubMed] [Google Scholar]
  35. Gough I. R., Mumme G. Biliary and duodenal bypass for carcinoma of the head of the pancreas. J Surg Oncol. 1984 Aug;26(4):282–284. doi: 10.1002/jso.2930260416. [DOI] [PubMed] [Google Scholar]
  36. Grace P. A., Pitt H. A., Longmire W. P. Pancreatoduodenectomy with pylorus preservation for adenocarcinoma of the head of the pancreas. Br J Surg. 1986 Aug;73(8):647–650. doi: 10.1002/bjs.1800730824. [DOI] [PubMed] [Google Scholar]
  37. 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]
  38. Grant C. S., Van Heerden J. A. Anastomotic ulceration following subtotal and total pancreatectomy. Ann Surg. 1979 Jul;190(1):1–5. doi: 10.1097/00000658-197907000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Gudjonsson B., Livstone E. M., Spiro H. M. Cancer of the pancreas: diagnostic accuracy and survival statistics. Cancer. 1978 Nov;42(5):2494–2506. doi: 10.1002/1097-0142(197811)42:5<2494::aid-cncr2820420554>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  40. Gunderson L. L., Martin J. K., Kvols L. K., Nagorney D. M., Fieck J. M., Wieand H. S., Martinez A., O'Connell M. J., Earle J. D., McIlrath D. C. Intraoperative and external beam irradiation +/- 5-FU for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 1987 Mar;13(3):319–329. doi: 10.1016/0360-3016(87)90005-8. [DOI] [PubMed] [Google Scholar]
  41. Hamano H., Hayakawa T., Kondo T. Serum immunoreactive elastase in diagnosis of pancreatic diseases. A sensitive marker for pancreatic cancer. Dig Dis Sci. 1987 Jan;32(1):50–56. doi: 10.1007/BF01296687. [DOI] [PubMed] [Google Scholar]
  42. 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]
  43. Hayes D. H., Bolton J. S., Willis G. W., Bowen J. C. Carcinoma of the ampulla of Vater. Ann Surg. 1987 Nov;206(5):572–577. doi: 10.1097/00000658-198711000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Herter F. P., Cooperman A. M., Ahlborn T. N., Antinori C. Surgical experience with pancreatic and periampullary cancer. Ann Surg. 1982 Mar;195(3):274–281. doi: 10.1097/00000658-198203000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Hiraoka T., Watanabe E., Mochinaga M., Tashiro S., Miyauchi Y., Nakamura I., Yokoyama I. Intraoperative irradiation combined with radical resection for cancer of the head of the pancreas. World J Surg. 1984 Oct;8(5):766–771. doi: 10.1007/BF01655776. [DOI] [PubMed] [Google Scholar]
  46. Hodgkinson D. J., ReMine W. H., Weiland L. H. A clinicopathologic study of 21 cases of pancreatic cystadenocarcinoma. Ann Surg. 1978 Nov;188(5):679–684. doi: 10.1097/00000658-197811000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Huibregtse K., Katon R. M., Coene P. P., Tytgat G. N. Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc. 1986 Oct;32(5):334–338. doi: 10.1016/s0016-5107(86)71878-6. [DOI] [PubMed] [Google Scholar]
  48. Huibregtse K., Tytgat G. N. Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut. 1982 May;23(5):371–375. doi: 10.1136/gut.23.5.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. 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]
  50. Itani K. M., Coleman R. E., Meyers W. C., Akwari O. E. Pylorus-preserving pancreatoduodenectomy. A clinical and physiologic appraisal. Ann Surg. 1986 Dec;204(6):655–664. doi: 10.1097/00000658-198612000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Jafri S. Z., Aisen A. M., Glazer G. M., Weiss C. A. Comparison of CT and angiography in assessing resectability of pancreatic carcinoma. AJR Am J Roentgenol. 1984 Mar;142(3):525–529. doi: 10.2214/ajr.142.3.525. [DOI] [PubMed] [Google Scholar]
  52. Jones B. A., Langer B., Taylor B. R., Girotti M. Periampullary tumors: which ones should be resected? Am J Surg. 1985 Jan;149(1):46–52. doi: 10.1016/s0002-9610(85)80008-8. [DOI] [PubMed] [Google Scholar]
  53. Joseph P. K., Bizer L. S., Sprayregen S. S., Gliedman M. L. Percutaneous transhepatic biliary drainage. Results and complications in 81 patients. JAMA. 1986 May 23;255(20):2763–2767. [PubMed] [Google Scholar]
  54. Kairaluoma M. I., Kiviniemi H., Ståhlberg M. Pancreatic resection for carcinoma of the pancreas and the periampullary region in patients over 70 years of age. Br J Surg. 1987 Feb;74(2):116–118. doi: 10.1002/bjs.1800740216. [DOI] [PubMed] [Google Scholar]
  55. Kalser M. H., Barkin J., MacIntyre J. M. Pancreatic cancer. Assessment of prognosis by clinical presentation. Cancer. 1985 Jul 15;56(2):397–402. doi: 10.1002/1097-0142(19850715)56:2<397::aid-cncr2820560232>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  56. Kalser M. H., Ellenberg S. S. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985 Aug;120(8):899–903. doi: 10.1001/archsurg.1985.01390320023003. [DOI] [PubMed] [Google Scholar]
  57. Kaufman S. L., Reddick R. L., Stiegel M., Wild R. E., Thomas C. G., Jr Papillary cystic neoplasm of the pancreas: a curable pancreatic tumor. World J Surg. 1986 Oct;10(5):851–859. doi: 10.1007/BF01655258. [DOI] [PubMed] [Google Scholar]
  58. Keighley M. R., Moore J., Thompson H. The place of fine needle aspiration cytology for the intraoperative diagnosis of pancreatic malignancy. Ann R Coll Surg Engl. 1984 Nov;66(6):405–408. [PMC free article] [PubMed] [Google Scholar]
  59. Kellum J. M., Clark J., Miller H. H. Pancreatoduodenectomy for resectable malignant periampullary tumors. Surg Gynecol Obstet. 1983 Oct;157(4):362–366. [PubMed] [Google Scholar]
  60. Kessler I. I. Cancer mortality among diabetics. J Natl Cancer Inst. 1970 Mar;44(3):673–686. [PubMed] [Google Scholar]
  61. Klaassen D. J., MacIntyre J. M., Catton G. E., Engstrom P. F., Moertel C. G. Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. J Clin Oncol. 1985 Mar;3(3):373–378. doi: 10.1200/JCO.1985.3.3.373. [DOI] [PubMed] [Google Scholar]
  62. Klöppel G., Lohse T., Bosslet K., Rückert K. Ductal adenocarcinoma of the head of the pancreas: incidence of tumor involvement beyond the Whipple resection line. Histological and immunocytochemical analysis of 37 total pancreatectomy specimens. Pancreas. 1987;2(2):170–175. [PubMed] [Google Scholar]
  63. Köhler H., Lankisch P. G. Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma. Pancreas. 1987;2(1):117–119. doi: 10.1097/00006676-198701000-00018. [DOI] [PubMed] [Google Scholar]
  64. Kümmerle F., Rückert K. Surgical treatment of pancreatic cancer. World J Surg. 1984 Dec;8(6):889–894. doi: 10.1007/BF01656029. [DOI] [PubMed] [Google Scholar]
  65. Lea M. S., Stahlgren L. H. Is resection appropriate for adenocarcinoma of the pancreas? A cost-benefit analysis. Am J Surg. 1987 Dec;154(6):651–654. doi: 10.1016/0002-9610(87)90236-4. [DOI] [PubMed] [Google Scholar]
  66. Lerut J. P., Gianello P. R., Otte J. B., Kestens P. J. Pancreaticoduodenal resection. Surgical experience and evaluation of risk factors in 103 patients. Ann Surg. 1984 Apr;199(4):432–437. doi: 10.1097/00000658-198404000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Leung J. W., Bowen-Wright M., Aveling W., Shorvon P. J., Cotton P. B. Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis. Br J Surg. 1983 Dec;70(12):730–732. doi: 10.1002/bjs.1800701212. [DOI] [PubMed] [Google Scholar]
  68. Leung J. W., Emery R., Cotton P. B., Russell R. C., Vallon A. G., Mason R. R. Management of malignant obstructive jaundice at The Middlesex Hospital. Br J Surg. 1983 Oct;70(10):584–586. doi: 10.1002/bjs.1800701006. [DOI] [PubMed] [Google Scholar]
  69. Lightwood R., Reber H. A., Way L. W. The risk and accuracy of pancreatic biopsy. Am J Surg. 1976 Aug;132(2):189–194. doi: 10.1016/0002-9610(76)90046-5. [DOI] [PubMed] [Google Scholar]
  70. Longmire W. P., Jr Cancer of the pancreas: palliative operation, Whipple procedure, or total pancreatectomy. World J Surg. 1984 Dec;8(6):872–879. doi: 10.1007/BF01656027. [DOI] [PubMed] [Google Scholar]
  71. Mackie C. R., Noble H. G., Cooper M. J., Collins P., Block G. E., Moossa A. R. Prospective evaluation of angiography in the diagnosis and management of patients suspected of having pancreatic cancer. Ann Surg. 1979 Jan;189(1):11–17. doi: 10.1097/00000658-197901000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Mahvi D. M., Meyers W. C., Bast R. C., Seigler H. F., Metzgar R. S. Carcinoma of the pancreas. Therapeutic efficacy as defined by a serodiagnostic test utilizing a monoclonal antibody. Ann Surg. 1985 Oct;202(4):440–445. doi: 10.1097/00000658-198510000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. Malagelada J. R. Pancreatic cancer: an overview of epidemiology, clinical presentation, and diagnosis. Mayo Clin Proc. 1979 Jul;54(7):459–467. [PubMed] [Google Scholar]
  74. Malesci A., Tommasini M. A., Bonato C., Bocchia P., Bersani M., Zerbi A., Beretta E., Di Carlo V. Determination of CA 19-9 antigen in serum and pancreatic juice for differential diagnosis of pancreatic adenocarcinoma from chronic pancreatitis. Gastroenterology. 1987 Jan;92(1):60–67. doi: 10.1016/0016-5085(87)90840-7. [DOI] [PubMed] [Google Scholar]
  75. Matsuno S., Sato T. Surgical treatment for carcinoma of the pancreas. Experience in 272 patients. Am J Surg. 1986 Nov;152(5):499–504. doi: 10.1016/0002-9610(86)90214-x. [DOI] [PubMed] [Google Scholar]
  76. 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]
  77. Molt P., Hopfan S., Watson R. C., Botet J. F., Brennan M. F. Intraluminal radiation therapy in the management of malignant biliary obstruction. Cancer. 1986 Feb 1;57(3):536–544. doi: 10.1002/1097-0142(19860201)57:3<536::aid-cncr2820570322>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  78. Moossa A. R., Levin B. The diagnosis of "early" pancreatic cancer: the University of Chicago experience. Cancer. 1981 Mar 15;47(6 Suppl):1688–1697. doi: 10.1002/1097-0142(19810315)47:6+<1688::aid-cncr2820471438>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  79. Moossa A. R., Scott M. H., Lavelle-Jones M. The place of total and extended total pancreatectomy in pancreatic cancer. World J Surg. 1984 Dec;8(6):895–899. doi: 10.1007/BF01656030. [DOI] [PubMed] [Google Scholar]
  80. Nagai H., Kuroda A., Morioka Y. Lymphatic and local spread of T1 and T2 pancreatic cancer. A study of autopsy material. Ann Surg. 1986 Jul;204(1):65–71. doi: 10.1097/00000658-198607000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Nakayama T., Ikeda A., Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology. 1978 Mar;74(3):554–559. [PubMed] [Google Scholar]
  82. Nishimura A., Nakano M., Otsu H., Nakano K., Iida K., Sakata S., Iwabuchi K., Maruyama K., Kihara M., Okamura T. Intraoperative radiotherapy for advanced carcinoma of the pancreas. Cancer. 1984 Dec 1;54(11):2375–2384. doi: 10.1002/1097-0142(19841201)54:11<2375::aid-cncr2820541112>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  83. Nix G. A., Schmitz P. I., Wilson J. H., Van Blankenstein M., Groeneveld C. F., Hofwijk R. Carcinoma of the head of the pancreas. Therapeutic implications of endoscopic retrograde cholangiopancreatography findings. Gastroenterology. 1984 Jul;87(1):37–43. [PubMed] [Google Scholar]
  84. O'Connell M. J. Current status of chemotherapy for advanced pancreatic and gastric cancer. J Clin Oncol. 1985 Jul;3(7):1032–1039. doi: 10.1200/JCO.1985.3.7.1032. [DOI] [PubMed] [Google Scholar]
  85. Oster M. W., Gray R., Panasci L., Perry M. C. Chemotherapy for advanced pancreatic cancer. A comparison of 5-fluorouracil, adriamycin, and mitomycin (FAM) with 5-fluorouracil, streptozotocin, and mitomycin (FSM). Cancer. 1986 Jan 1;57(1):29–33. doi: 10.1002/1097-0142(19860101)57:1<29::aid-cncr2820570108>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  86. Ozaki H., Ishii K., Sato T., Karasawa E., Kitamura T., Tsuchiya R., Kasugai T., Abe M., Ueda M., Takeuchi T. Diagnosis of small pancreatic carcinoma. Jpn J Clin Oncol. 1985 Mar;15(1):115–120. [PubMed] [Google Scholar]
  87. Pasquali C., Sperti C., D'Andrea A. A., Bonadimani B., Del Favero G., Petrin P., Pedrazzoli S. Evaluation of carbohydrate antigens 19-9 and 12-5 in patients with pancreatic cancer. Pancreas. 1987;2(1):34–37. doi: 10.1097/00006676-198701000-00005. [DOI] [PubMed] [Google Scholar]
  88. Patti M. G., Pellegrini C. A., Way L. W. Gastric emptying and small bowel transit of solid food after pylorus-preserving pancreaticoduodenectomy. Arch Surg. 1987 May;122(5):528–532. doi: 10.1001/archsurg.1987.01400170034004. [DOI] [PubMed] [Google Scholar]
  89. Pedrazzoli S., Bonadimani B., Sperti C., Cappellazzo F., Piccoli A., Militello C. Forecast of surgical risk in pancreatic cancer. Am J Surg. 1987 Apr;153(4):374–377. doi: 10.1016/0002-9610(87)90580-0. [DOI] [PubMed] [Google Scholar]
  90. Piorkowski R. J., Blievernicht S. W., Lawrence W., Jr, Madariaga J., Horsley J. S., 3rd, Neifeld J. P., Terz J. J. Pancreatic and periampullary carcinoma. Experience with 200 patients over a 12 year period. Am J Surg. 1982 Feb;143(2):189–193. doi: 10.1016/0002-9610(82)90064-2. [DOI] [PubMed] [Google Scholar]
  91. 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]
  92. Podolsky D. K. Serologic markers in the diagnosis and management of pancreatic carcinoma. World J Surg. 1984 Dec;8(6):822–830. doi: 10.1007/BF01656021. [DOI] [PubMed] [Google Scholar]
  93. Rong G. H., Sindelar W. F. Aberrant peripancreatic arterial anatomy. Considerations in performing pancreatectomy for malignant neoplasms. Am Surg. 1987 Dec;53(12):726–729. [PubMed] [Google Scholar]
  94. Rosenberg J. M., Welch J. P., Macaulay W. P. Cancer of the head of the pancreas: an institutional review with emphasis on surgical therapy. J Surg Oncol. 1985 Mar;28(3):217–221. doi: 10.1002/jso.2930280315. [DOI] [PubMed] [Google Scholar]
  95. Rypins E. B., Bitzer L. G., Sarfeh I. J., Juler G. L. The role of percutaneous transhepatic internal biliary drainage in preoperative patients. Am Surg. 1987 Oct;53(10):562–564. [PubMed] [Google Scholar]
  96. Safi F., Roscher R., Bittner R., Schenkluhn B., Dopfer H. P., Beger H. G. High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings. Pancreas. 1987;2(4):398–403. doi: 10.1097/00006676-198707000-00006. [DOI] [PubMed] [Google Scholar]
  97. Sakamoto K., Haga Y., Yoshimura R., Egami H., Yokoyama Y., Akagi M. Comparative effectiveness of the tumour diagnostics, CA 19-9, CA 125 and carcinoembryonic antigen in patients with diseases of the digestive system. Gut. 1987 Mar;28(3):323–329. doi: 10.1136/gut.28.3.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  98. Sarr M. G., Cameron J. L. Surgical management of unresectable carcinoma of the pancreas. Surgery. 1982 Feb;91(2):123–133. [PubMed] [Google Scholar]
  99. Savarino V., Mansi C., Bistolfi L., Zentilin P., Celle G. Failure of new diagnostic aids in improving detection of pancreatic cancer at a resectable stage. Dig Dis Sci. 1983 Dec;28(12):1078–1082. doi: 10.1007/BF01295805. [DOI] [PubMed] [Google Scholar]
  100. Schantz S. P., Schickler W., Evans T. K., Coffey R. J. Palliative gastroenterostomy for pancreatic cancer. Am J Surg. 1984 Jun;147(6):793–796. doi: 10.1016/0002-9610(84)90203-4. [DOI] [PubMed] [Google Scholar]
  101. Schouten J. T. Operative therapy for pancreatic carcinoma. Am J Surg. 1986 May;151(5):626–630. doi: 10.1016/0002-9610(86)90575-1. [DOI] [PubMed] [Google Scholar]
  102. Schuster-Uitterhoeve A. L., Gonzalez Gonzalez D., Blank L. E. Radiotherapy with multiple fractions per day in pancreatic and bile duct cancer. Radiother Oncol. 1986 Nov;7(3):205–213. doi: 10.1016/s0167-8140(86)80031-7. [DOI] [PubMed] [Google Scholar]
  103. Scott H. W., Jr, Dean R. H., Parker T., Avant G. The role of vagotomy in pancreaticoduodenectomy. Ann Surg. 1980 Jun;191(6):688–696. doi: 10.1097/00000658-198006000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  104. Shapiro T. M. Adenocarcinoma of the pancreas: a statistical analysis of biliary bypass vs Whipple resection in good risk patients. Ann Surg. 1975 Dec;182(6):715–721. doi: 10.1097/00000658-197512000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  105. Sheth N., Dalbagni G., Rothenberg R. E., LaRaja R. D. Carcinoma of the pancreas in nonjaundiced patients. A silent disease. Am Surg. 1985 May;51(5):252–255. [PubMed] [Google Scholar]
  106. Shipley W. U., Tepper J. E., Warshaw A. L., Orlow E. L. Intraoperative radiation therapy for patients with pancreatic carcinoma. World J Surg. 1984 Dec;8(6):929–934. doi: 10.1007/BF01656034. [DOI] [PubMed] [Google Scholar]
  107. Shipley W. U., Wood W. C., Tepper J. E., Warshaw A. L., Orlow E. L., Kaufman S. D., Battit G. E., Nardi G. L. Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma. Ann Surg. 1984 Sep;200(3):289–296. doi: 10.1097/00000658-198409000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  108. Siegel J. H., Snady H. The significance of endoscopically placed prostheses in the management of biliary obstruction due to carcinoma of the pancreas: results of nonoperative decompression in 277 patients. Am J Gastroenterol. 1986 Aug;81(8):634–641. [PubMed] [Google Scholar]
  109. Silverstein M. D., Richter J. M., Podolsky D. K., Warshaw A. L. Suspected pancreatic cancer presenting as pain or weight loss: analysis of diagnostic strategies. World J Surg. 1984 Dec;8(6):839–845. doi: 10.1007/BF01656023. [DOI] [PubMed] [Google Scholar]
  110. Sivak M. V., Kaufman A. Endoscopic ultrasonography in the differential diagnosis of pancreatic disease. A preliminary report. Scand J Gastroenterol Suppl. 1986;123:130–134. doi: 10.3109/00365528609091874. [DOI] [PubMed] [Google Scholar]
  111. Skibber J. M., Weiss S. M., Mohiuddin M., Rosato F. E. Impact of radiotherapy on palliative gastroenterostomy in pancreatic cancer. Ann Surg. 1985 Dec;202(6):725–728. doi: 10.1097/00000658-198512000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  112. Smith R. C., Lin B. P., Loughman N. T. Operative fine needle aspiration cytology of pancreatic tumours. Aust N Z J Surg. 1985 Apr;55(2):145–148. doi: 10.1111/j.1445-2197.1985.tb00874.x. [DOI] [PubMed] [Google Scholar]
  113. Smith R. C., Pooley M., George C. R., Faithful G. R. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function. Surgery. 1985 Jun;97(6):641–648. [PubMed] [Google Scholar]
  114. Speer A. G., Cotton P. B., Russell R. C., Mason R. R., Hatfield A. R., Leung J. W., MacRae K. D., Houghton J., Lennon C. A. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987 Jul 11;2(8550):57–62. doi: 10.1016/s0140-6736(87)92733-4. [DOI] [PubMed] [Google Scholar]
  115. Steinberg W. M., Gelfand R., Anderson K. K., Glenn J., Kurtzman S. H., Sindelar W. F., Toskes P. P. Comparison of the sensitivity and specificity of the CA19-9 and carcinoembryonic antigen assays in detecting cancer of the pancreas. Gastroenterology. 1986 Feb;90(2):343–349. doi: 10.1016/0016-5085(86)90930-3. [DOI] [PubMed] [Google Scholar]
  116. Suzuki T., Imamura M., Tamura K., Sumiyoshi A., Sakanashi S., Nishimura Y., Tobe T. Correlative evaluation of angiography and pancreatoductography in relation to surgery for cancer of the pancreas. Surgery. 1979 Jun;85(6):644–651. [PubMed] [Google Scholar]
  117. Syed A. M., Puthawala A. A., Neblett D. L. Interstitial iodine-125 implant in the management of unresectable pancreatic carcinoma. Cancer. 1983 Sep 1;52(5):808–813. doi: 10.1002/1097-0142(19830901)52:5<808::aid-cncr2820520510>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  118. Tatsuta M., Yamamoto R., Yamamura H., Okuda S., Tamura H. Cytologic examination and CEA measurement in aspirated pancreatic material collected by percutaneous fine-needle aspiration biopsy under ultrasonic guidance for the diagnosis of pancreatic carcinoma. Cancer. 1983 Aug 15;52(4):693–698. doi: 10.1002/1097-0142(19830815)52:4<693::aid-cncr2820520422>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  119. Tatsuta M., Yamamura H., Iishi H., Ichii M., Noguchi S., Yamamoto R., Okuda S. Values of CA 19-9 in the serum, pure pancreatic juice, and aspirated pancreatic material in the diagnosis of malignant pancreatic tumor. Cancer. 1985 Dec 1;56(11):2669–2673. doi: 10.1002/1097-0142(19851201)56:11<2669::aid-cncr2820561124>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  120. Tepper J. E., Shipley W. U., Warshaw A. L., Nardi G. L., Wood W. C., Orlow E. L. The role of misonidazole combined with intraoperative radiation therapy in the treatment of pancreatic carcinoma. J Clin Oncol. 1987 Apr;5(4):579–584. doi: 10.1200/JCO.1987.5.4.579. [DOI] [PubMed] [Google Scholar]
  121. Tio T. L., Tytgat G. N. Endoscopic ultrasonography in staging local resectability of pancreatic and periampullary malignancy. Scand J Gastroenterol Suppl. 1986;123:135–142. doi: 10.3109/00365528609091875. [DOI] [PubMed] [Google Scholar]
  122. Traverso L. W., Longmire W. P., Jr Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg. 1980 Sep;192(3):306–310. doi: 10.1097/00000658-198009000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  123. Trede M., Schwall G. The complications of pancreatectomy. Ann Surg. 1988 Jan;207(1):39–47. doi: 10.1097/00000658-198801000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  124. Trede M. The surgical treatment of pancreatic carcinoma. Surgery. 1985 Jan;97(1):28–35. [PubMed] [Google Scholar]
  125. Trede M. Treatment of pancreatic carcinoma: the surgeon's dilemma. Br J Surg. 1987 Feb;74(2):79–80. doi: 10.1002/bjs.1800740202. [DOI] [PubMed] [Google Scholar]
  126. Tryka A. F., Brooks J. R. Histopathology in the evaluation of total pancreatectomy for ductal carcinoma. Ann Surg. 1979 Sep;190(3):373–381. doi: 10.1097/00000658-197909000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  127. Tsang T. K., Crampton A. R., Bernstein J. R., Ramos S. R., Wieland J. M. Percutaneous-endoscopic biliary stent placement. A preliminary report. Ann Intern Med. 1987 Mar;106(3):389–392. doi: 10.7326/0003-4819-106-3-389. [DOI] [PubMed] [Google Scholar]
  128. Tsuchiya R., Henmi T., Kondo N., Akashi M., Harada N. Endoscopic aspiration biopsy of the pancreas. Gastroenterology. 1977 Nov;73(5):1050–1052. [PubMed] [Google Scholar]
  129. Tsuchiya R., Noda T., Harada N., Miyamoto T., Tomioka T., Yamamoto K., Yamaguchi T., Izawa K., Tsunoda T., Yoshino R. Collective review of small carcinomas of the pancreas. Ann Surg. 1986 Jan;203(1):77–81. doi: 10.1097/00000658-198601000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  130. Tweedle D. E. Peroperative transduodenal biopsy of the pancreas. Gut. 1979 Nov;20(11):992–996. doi: 10.1136/gut.20.11.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  131. Tønnesen K., Kamp-Jensen M. Antiestrogen therapy in pancreatic carcinoma: a preliminary report. Eur J Surg Oncol. 1986 Mar;12(1):69–70. [PubMed] [Google Scholar]
  132. Ubhi C. S., Doran J. Palliation for carcinoma of head of pancreas. Ann R Coll Surg Engl. 1986 May;68(3):159–162. [PMC free article] [PubMed] [Google Scholar]
  133. Wang T. H., Lin J. T., Chen D. S., Sheu J. C., Sung J. L. Noninvasive diagnosis of advanced pancreatic cancer by real-time ultrasonography, carcinoembryonic antigen, and carbohydrate antigen 19-9. Pancreas. 1986;1(3):219–223. doi: 10.1097/00006676-198605000-00004. [DOI] [PubMed] [Google Scholar]
  134. Warshaw A. L. Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis. Am J Surg. 1985 Apr;149(4):563–569. doi: 10.1016/s0002-9610(85)80057-x. [DOI] [PubMed] [Google Scholar]
  135. Warshaw A. L., Jin G. L., Ottinger L. W. Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis. Arch Surg. 1987 Apr;122(4):410–415. doi: 10.1001/archsurg.1987.01400160036003. [DOI] [PubMed] [Google Scholar]
  136. Warshaw A. L., Richter J. M., Podolsky D. K., Mueller P. R., Ferrucci J. T., Jr, Shipley W. U. A strategy against pancreatic cancer. J Clin Gastroenterol. 1982 Dec;4(6):525–532. doi: 10.1097/00004836-198212000-00009. [DOI] [PubMed] [Google Scholar]
  137. Warshaw A. L., Rutledge P. L. Cystic tumors mistaken for pancreatic pseudocysts. Ann Surg. 1987 Apr;205(4):393–398. doi: 10.1097/00000658-198704000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  138. Warshaw A. L., Tepper J. E., Shipley W. U. Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg. 1986 Jan;151(1):76–80. doi: 10.1016/0002-9610(86)90015-2. [DOI] [PubMed] [Google Scholar]
  139. Warshaw A. L., Torchiana D. L. Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy. Surg Gynecol Obstet. 1985 Jan;160(1):1–4. [PubMed] [Google Scholar]
  140. Weaver D. W., Wiencek R. G., Bouwman D. L., Walt A. J. Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery. 1987 Oct;102(4):608–613. [PubMed] [Google Scholar]
  141. Weiss S. M., Skibber J. M., Mohiuddin M., Rosato F. E. Rapid intra-abdominal spread of pancreatic cancer. Influence of multiple operative biopsy procedures. Arch Surg. 1985 Apr;120(4):415–416. doi: 10.1001/archsurg.1985.01390280009001. [DOI] [PubMed] [Google Scholar]
  142. Whittington R., Solin L., Mohiuddin M., Cantor R. I., Rosato F. E., Biermann W. A., Weiss S. M., Pajak T. F. Multimodality therapy of localized unresectable pancreatic adenocarcinoma. Cancer. 1984 Nov 1;54(9):1991–1998. doi: 10.1002/1097-0142(19841101)54:9<1991::aid-cncr2820540934>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  143. Whittington R., Solin L., Mohiuddin M., Cantor R. I., Rosato F. E., Biermann W. A., Weiss S. M., Pajak T. F. Multimodality therapy of localized unresectable pancreatic adenocarcinoma. Cancer. 1984 Nov 1;54(9):1991–1998. doi: 10.1002/1097-0142(19841101)54:9<1991::aid-cncr2820540934>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  144. Wittenberg J., Ferrucci J. T., Warshaw A. L. Contribution of computed tomography to patients with pancreatic adenocarcinoma. World J Surg. 1984 Dec;8(6):831–838. doi: 10.1007/BF01656022. [DOI] [PubMed] [Google Scholar]
  145. Wong J. H., Krippaehne W. W., Fletcher W. S. Percutaneous transhepatic biliary decompression. Results and complications in 30 patients. Am J Surg. 1984 May;147(5):615–617. doi: 10.1016/0002-9610(84)90125-9. [DOI] [PubMed] [Google Scholar]
  146. van Heerden J. A. Pancreatic resection for carcinoma of the pancreas: Whipple versus total pancreatectomy--an institutional perspective. World J Surg. 1984 Dec;8(6):880–888. doi: 10.1007/BF01656028. [DOI] [PubMed] [Google Scholar]
  147. van Heerden J. A., ReMine W. H., Weiland L. H., McIlrath D. C., Ilstrup D. M. Total pancreatectomy for ductal adenocarcinoma of the pancreas. Mayo Clinic experience. Am J Surg. 1981 Sep;142(3):308–311. doi: 10.1016/0002-9610(81)90336-6. [DOI] [PubMed] [Google Scholar]

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