Surgery for Pancreatic Cancer: Progress and Problems

Abstract

A century ago, as the discipline of surgery, with the development of anesthesia and some understanding of sepsis, was emerging as a skilled, humane treatment for an increasing number of human illnesses, surgeons took up an interest in that hidden and somewhat mysterious organ, the pancreas. Surgeons such as Nicholas Senn [1], Robert Coffey [2], and Sauve [3] were conducting extensive experimental studies on methods of resection and anastomosis, the effects of pancreatic secretion in the peritoneal cavity, and the healing process of the traumatized or incised gland. During the same period, an occasional surgeon was making hesitant efforts toward the treatment of clinical pancreatic disease. Despite Halsted’s report in 1899 of the first successful resection of an ampullary carcinoma [4], a favorable outcome following operation on the pancreas was rare, prompting Von Mikulicz- Radecki to comment in 1902 in his invitational presentation before the Congress of American Physicians and Surgeons [5] that “operative interference for disease of the pancreas is still, at the present time, the most incomplete chapter in the realm of abdominal surgery.” In the thirty operations on the pancreas reported by Von Mikulicz-Radecki, there was a single excision of a tumor in the head of the pancreas with a fatal outcome.