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Pancreatoduodenectomy for Periampullary Carcinoma:  An Evaluation of Technique, Mortality, and Results

WILBUR HILST, M.D.; CHARLES KOUCKY, M.D.; LOUIS KAUFMAN, M.D.; GERALD S. WILSON, M.D.
AMA Arch Surg. 1959;78(5):738-744. doi:10.1001/archsurg.1959.04320050069011.
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Pancreatoduodenectomy for periampullary carcinoma is undergoing a period of renewed interest because of the constantly increasing number of reported five-year survivors, all of whom without this surgery would be destined to an early death.1-5 This operation, however, is a formidable one, generally associated with a high operative mortality and morbidity and low cure rate. In addition, the over-all resectability of periampullary lesions is low, even in those patients who have had symptoms for a relatively short length of time. It would appear that one of the ways to increase the number of cures would be to reduce the operative mortality in the group in which all grossly malignant tissue can be removed at the time of operation.

One of the commonest causes of operative mortality has been the high incidence of fistula formation at or near the pancreatic anastomosis.6 With this in mind, a study of our cases

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