Current status of pancreaticoduodenectomy for periampullary carcinoma

D. W. Crist, J. L. Cameron

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Pancreaticoduodenectomy has undergone numerous modifications since the original descritpion by Whipple et al. of a successful two-stage radical resection of the head of the pancreas and duodenum in 1935. For most of the 50 years that the Whipple procedure has been performed, the morbidity and mortality rates have been high, and few long-term survivors have been reported. Over the past decade, a number of institutions have reported a dramatic decline in operative morbidity and mortality as well as an improved survival for those undergoing pancreaticoduodenal resection. Between 1969 and 1986, 88 patients underwent pancreaticoduodenal resection for periampullary cancer at the Johns Hopkins Hospital. In an effort to detect recent trends in operative morbidity and mortality for those undergoing pancreaticoduodenal resection, the patients were divided into two groups on the basis of two time periods. Forty-one patients underwent pancreaticoduodenectomy for periampullary cancer between 1969 and 1981, while 47 patients underwent pancreaticoduodenectomy between 1981 and 1986. Twere were no significant differences between the two groups in terms of mean age, sex distribution, duration of symptoms before presentation or mean weight loss. Likewise, preoperative laboratory data were similar for both groups of patients. In addition, mean tumor size was similar in both groups, as was the incidence of positive lymph nodes. Among the 41 patients operated upon during the first period, hospital morbidity and mortality rates were 59% and 24%, respectively. In contrast, hospital morbidity and mortality rates were 36% and 21%, respectively among the 47 patients operated upon during the recent period. During the recent period, more Whipple procedures were performed each year (7.8 vs. 3.4 and by fewer surgeons (3.4 operations/surgeon vs. 1.9 operations/surgeon). In addition, between 1981 and 1986, there were fewer total pancreatectomies (9% vs 39%), fewer vagotomies (26% vs. 76%), and more pylorus-sparing procedures (30% vs. 0%) performed compared with the earlier period. During the recent period, mean estimated blood loss (1,694 vs 3,271 cc), mean intraoperative blood replacement (3.6 vs. 6.3 units), and mean operating time (7.8 vs. 9.0 hours) were all significantly less than the earlier period. These findings suggest that the decline in operative morbidity and mortality observed during the recent time period may be due to fewer, more experienced surgeons performing more Whipple resections in less time and with less blood loss. The actuarial 5-year survival rate for the 38 patients with nonpancreatic periampullary cancer was 34%. Surprisingly, the actuarial 5-year survival rate among the 50 patients with pancreatic cancer was 18%. Moreover, in the absence of positive lymph node involvement, the 5-year actuarial survival rate among patients with pancreatic cancer was 48%. No explanation is obvious for the improvement in survival among patients with pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)478-485
Number of pages8
Issue number6
StatePublished - Dec 1 1989
Externally publishedYes


  • pancreatic cancer
  • pancreaticoduodenal resection
  • pancreaticoduodenectomy
  • periampullary cancer
  • whipple procedure

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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