Pancreatico-duodenal resection for carcinoma.

Summary 1 Early and accurate diagnosis of carcinoma of the pancreas and the ampulla of Vater can be assised by the use of bio- chemical tests and perhaps liver biopsy. Early laparotomy is essential to avoid further liver damage and spread of the tumour. 2 The general clinical improvement of the patients and the improvement of these tests have shown the value of preliminary decompression of the biliary system be- fore pancreatico-duodenal resection. A two stage operation is therefore recom- mended. 3 The diagnosis of small tumours of the ampulla or head of the pancreas is dis- cussed and its importance emphasised as the most difficult tumours to diagnose will probably have the best prognoses. 4 A detailed description of the steps in pancreatico-duodenal resection is given, with illustrations. The hazards are em- phasized. 5 The results of resection in eight cases are recorded.