SURGICAL PROBLEM OF PERIAMPULLARY CANCER

IN NO GROUP of intra-abdominal tumors has the presence of cancer been so consistently and early indicated by distressing and compelling symptoms as in those lesions producing obstructive jaundice. The scope of operations for gastric, colonic and rectal cancer has increased greatly to include not only the organ involved and its immediate lymphatic tributaries but also adjacent invaded structures regardless of the demand made on already altered physiologic economy. However, cancer producing biliary obstruction discouraged for many years the application of the acceptable surgical principles involved in excision of a tumor and in dissection of its lymphatic bed in continuity. It remained for Whipple and his colleagues,¹ encouraged by their studies on resection of the body and tail of the pancreas in patients with hyperinsulinism and discouraged by the not unusual complications of local excision of periampullary tumors, to redefine the issue and to plan, execute and popularize an