Does pancreatoduodenectomy with resection of limited hepatic metastases have a potential role in the treatment of selected patients with carcinoma of the exocrine pancreas?
Most patients with carcinoma of the exocrine pancreas who undergo a "curative" pancreatoduodenectomy die of recurrent cancer, reflecting the presence of residual micrometastases at the time of resection. In this sense, almost all such resections have been palliative.
Vanhooser and Organ,1 after reviewing an experience between 1980 and 1986 in which there was no 5-year survival after pancreatoduodenectomy for exocrine pancreatic carcinoma, recommended that the Whipple resection be used more aggressively for palliation by experienced surgeons. Watanapa and Williamson2 suggested the possibility of palliative resection in young people whose disease was limited but incurable. Earlier, Forest and Longmire3 had proposed that possibility.
Based on a low postoperative mortality rate after pancreatoduodenectomy and the inadequacy of palliation in most patients who had not undergone