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p” LLIATIVE operations are freThe patients were, in generaI, in very quentIy performed on patients with poor physica condition by the time they far advanced cancer, in order to arrived for treatment, and in spite of a reIieve them of painfu1 manifestations carefu1 preoperative regime of high ffuid of the disease and to proIong their Iives. and high carbohydrate intake and transThe vaIue of some of these operations is fusions, they often remained desperate we11 estabIished, of others it is stiI1 under surgica1 risks, to be operated upon onIy question. To be worth whiIe, a paIIiative after the most serious consideration. operation done for an eventuaIIy fatal The Iiterature on carcinoma of the head Iesion must, in fact, either free the patient of the pancreas dates back to the first from an intoIerabIe symptom or proIong description of the condition by Mondiere’ Iife that at the same time is made comfortin 1836. Certain cIassica1 papers have been abIe enough to be worth the Iiving. written since then, notabIy the papers by If one advises such a paIIiative operaDaCosta2 in 1858, AnceIet3 in 1864, Bard tion, the risks and benefits shouId be and Pic4 in 1888, MiraIIie5 in 1893, understood so that they may be cIearIy Herringham in 1894, Oser’ in 1898, and presented to the patient or his famiIy. HuIst* in 1905. Since I g Ig severa imporFor this purpose, therefore, many studies tant papers have been added, among these of the end-resuIts of such operative probeing those of Futcherg in IgIg, SpeedlO cedures must be made, which are as yet in 1920, Eustermanll in 1922, Parmentier far from being compIete. and ChabeI12 in 1923, Kiefer13 in 1927, BiIiary intestina1 anastomosis for obi and FriedenwaId and CuIIen14 in 1929. structive jaundice due to carcinoma of the There has been a comparativeIy smaI1 head of the pancreas or of the biIe ducts number of articIes in recent years and this is a paIIiative operation, the resuIts of is particuIarIy true of those deaIing with which are not yet cIarified by a Iarge the postoperative resuIts folIowing paIIianumber of studies of end-resuIts. In an tive operations. In 1928 Judd and Parker15 endeavor to find whether this procedure discussed carcinoma of the pancreas from was worth whiIe in our hands, we have this point of view in a paper on “AnastofoIIowed the course of 30 patients with mosis for Obstructive Jaundice.” cancer of the head of the pancreas on The maIady is most often seen in the whom some form of biIiary intestina1 Iarge genera1 hospitaIs and statistics show anastomosis was performed. that I to 2 per cent of the tota number of The diagnosis of carcinoma of the head cancers are found in the pancreas. Twentyof the pancreas was not confirmed by nine cases of cancer of the pancreas, positive microscopic evidence except in either primary or secondary, were found those cases that came to autopsy; in the in 23,61 I coIIected autopsies in Vienna by others it was made on the gross examinaBiach.16 Of 41,949 patients admitted to tion carried out during the examination, a the medica wards of Johns Hopkins method obviousIy not entireIy reIiabIe. HospitaI, a cIinica1 diagnosis of cancer * From the Department of Surgery, University of Michigan. |
