Total Pancreatectomy for Cancer An appraisal of 65 cases

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Abstract
Sixty-five patients treated 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 3, cancer of the bile duct in 2 and leiomyosarcoma of the duodenum and cystadenocarcinoma of the pancreas in 1 patient, respectively. In 9 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 preoperative bilirubin levels seemed to influence survival time. Among 24 patients operated before 1975 in whom the operating surgeon judged the operation as radical, a 5 yr survival of 21% was recorded. In patients without detectable lymph node metastases, the mean survival time was 25 mo. Postoperative exocrine insufficiency and diabetes were possible to control. A blood sugar level above 10 .mu.mol/l decreased the frequency of hypoglycemic attacks. Total pancreatectomy appears to be the surgical procedure preferred when radical treatment is selected.

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