In a county hospital, 217 patients were operated on for suspected cancer of the pancreas (186 patients) and periampullary structures (31 patients). The surgeons' philosophy was to avoid biopsy of the pancreas whenever possible, they often performed radical resection based on clinical judgment alone (8% of the resections were chronic pancreatitis). Follow-up of the 65 patients who were presumed to have carcinoma without histologic proof showed the surgeon's clinical diagnosis to be incorrect in over 7% of the cases (maximum error -18%). Among patients with carcinoma of the pancreas, one third of the pancreatic biopsies missed the lesion (surgeon's sampling error). Frozen section examination of pancreatic biopsies in 63 patients showed false positive and negative rates of 3% and 4%' respectively (pathologist's sampling or interpretation errors). Two of 31 incisional biopsy of the pancreas resulted in pancreatic fistula; none of 24 needle biopsies did. Otherwise, biopsy of the pancreas did not influence mortality or morbidity after either resection or bypass procedures.
Cancer 49:1035-1039, 1982.
ISTINCTION BETWEEN CHRONIC PANCREATITIS and D carcinoma arising in the head of the pancreas and periampullary structures may be difficult or impossible for the surgeon at the time of operation. This may also challenge the pathologist examining frozen sections of biopsy material. Many surgeons rely on clinical judgement for doing pancreaticoduodenal resection.' Others feel that a positive tissue diagnosis is essential before proceeding with this formidable surgical procedure.* For unresectable carcinoma localized to the pancreas, and even for resectable lesions, some surgeons favor bypass operation only.3 Regionally directed radiother-apy4 and systemic ~hemotherapy'.~ are being tried to improve the survival rate. Microscopic confirmation of the malignant lesion is a prerequisite for such therapy in protocol studies.
If one believes that a histologic diagnosis is not necessary before performing a pancreaticoduodenectomy, the morbidity, mortality, and long-term survival of this therapy for pancreatic and periampullary carcinomas must be assessed against the possibility of doing such radical operation for benign lesions. How often does