Pancreaticoduodenectomy
Introduction
Resection of tumors of the periampullary region has its origins in the writings of Kausch (1912) and Whipple (1935). Pancreaticoduodenectomy, or pancreatoduodenectomy, previously was accompanied by a mortality rate of 20% to 25%. Currently, however, most experienced pancreatic surgery centers report a mortality rate of 3% or less. Complication rates remain 20% to 50%, with the most troublesome complication being leakage at the pancreatic anastomosis.
Principles of Pancreatic Cancer Treatment
The treatment of pancreatic cancer begins with accurate staging, including a complete history and physical examination. The most important component of staging is a multiphase computed tomography (CT) scan of the abdomen using a multidetector scanner (Fig. 16-1). With CT of the chest, this allows patients to be staged clinically as resectable (15% to 25%), borderline resectable or locally advanced/unresectable (30% to 40%), or metastatic (40% to 50%). Endoscopic ultrasound is rarely needed for staging purposes, and laparoscopy is favored by some authors. Debate continues about the utility of preoperative biliary decompression in jaundiced patients. Recently, laparoscopic approaches to pancreaticoduodenectomy have been described, but these remain nascent.