Arch Surg. 1964;89(2):331-339. doi:10.1001/archsurg.1964.01320020095015.
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Since 1935 when Whipple et al1 described a procedure for resecting the head of the pancreas, discussion has continued concerning the indications for this operation. That this question remains unresolved is indicated by the differences of opinion expressed by competent surgeons in the current medical literature. At one extreme is the pessimistic view that pancreatoduodenectomy is rarely if ever indicated for treatment of carcinoma of the head of the pancreas.2 In contrast is the optimistic view suggesting that the operation should be used to treat carcinoma of the head of the pancreas as well as carcinoma of the ampulla of Vater.3 High operative mortality and postoperative morbidity rates are the principal reasons for the continued caution concerning the indication for this operation. Reported operative mortality rates vary between 6.5%4 and 47%.5 To justify an operative risk of this magnitude it is necessary to have evidence


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