Operative approach to XXXX and the peri-ampullary region.

@entity1 @entity135 @entity1087 @entity5
A retrospective study was made of 75 consecutive @entity1 treated for a @entity5 of the head of the pancreas and the peri-ampullary region from January 1978 to August 1981. These @entity1 underwent either pancreatic resection--pancreatoduodenectomy (n = 24) and total pancreatectomy (n = 10)--palliative procedures (n = 29) or exploratory laparotomy (n = 12). Clinical signs and diagnostic procedures, such as ultrasonography and coeliac arteriography, were studied for their value in preoperative assessment of operability. Vaso-invasion, as revealed by arteriography and, to a lesser extent, ultrasonographic signs of a @entity5 and the absence of @entity1087 were poor prognostic signs. The operative mortality was 8 per cent for the group as a whole, but somewhat higher (13 per cent) for the group that underwent pancreatoduodenectomy. No @entity1 died after total pancreatectomy. The operative mortality was 27 per cent in all @entity1 aged 70 years or older, but only 3 per cent in @entity1 under 70 years. One-year @entity1 survival was 94 per cent after pancreatoduodenectomy for @entity5 and 57 per cent after resection for @entity135 . The results of this study point to pancreatic resection as the treatment of choice for resectable @entity5 of the peri-ampullary region and the head of the pancreas in @entity1 under 70 years of age. Coeliac arteriography and ultrasonography have been found to be useful for preoperative classification of @entity5 stage.
