STUDY ON SURGICAL MANGEMENT OF CANCER OF THE HEAD OF THE PANCREAS

Abstract

The present study includes 75 patients with cancer head of the pancreas treated in Tanta university hospitals ( Egypt ) and Ulm university hospitals ( Germany ) in the period from November 1997, to Apri12001 . The age of the patients ranged from 21 to 87 year with a mean age of 54 + 9.58

year . the main presenting symptoms in our patients were jaundice , loss of weight and upper abdominal pain while the main presenting signs were jaundice, hepatomegaly and palpable gall bladder. All patients underwent preoperative laboratory and radiological investigation for assessment of tumour resectability . After full preoperative evaluation , 011r patient , were treated as following .

A- Unresectable group (( 30 patients)) I- Non operative bypass ( Endoprothesis) in 5 patients ( 6.6%)

2- Surgical bypass : in 25 patients ( 33.3 % ) biliary bypass in 15 patients and biliavy and gastric bypass in 10 patients . B- Resectanle group ( 45 patients ) ( 60 •;., ) : -

Pancreaticoduodenectomy was performed in all patients classic whipple's in 5 patient ( 11.1 % ) and pylorus preserving pancreaticoduobenectomy in 40 patients ( 88.9%). Extensive lymph node dissection was a routine step except in 3 cases with vascular invasion and one case of transverse colon resection . The operative time lasted an average of 5.5 hours with median of 5 hours ( range :

3.5 - 8 hours ) histopathological examination revealed that the tumour was adenocarcinoma of the pancreas. Postoperative complicetion occurred in 18 patient's ( 40 % ) , hemorrhage occurred in 3 patients ( 6.6 % ) , one patients was major hemorrhage and needed for re exploration for haemstasis. In the other two patients , bleeding was minor and respond to conservative treatement . One patients developed gastrointestinal bleeding ( 2.2 % ) . Biliary fistula occurred in two patient ( 4.4 % ) but no need for surgical

intervention .