OBJECTIVETo compare the outcomes of patients undergoing surgical treatment for pancreatic head carcinomas during different time course over 40 years in one hospital.

METHODSTotally 346 cases of pancreatic head carcinoma in one hospital were retrospectively analyzed during the periods of 1958-1976, 1977-1987, 1988-1998, and 1999-2003.

RESULTSDuring the period of 1958-1976, 79 patients with pancreatic head carcinoma were diagnosed and the rate of pancreaticoduodenectomy (PD) was 20.6% (21/79). During the period of 1977-1987, 60 patients with pancreatic head carcinoma were diagnosed and the PD rate was 26.7% (16/60). During the period of 1988-1998, 109 patients with pancreatic head carcinoma were diagnosed and the resection rate was 20.18% (22/109). During the period of 1999-2003, 98 patients with pancreatic head carcinoma were diagnosed and the resection rate was 22.4% (20/98). The total resection rate of pancreatic head carcinomas was 22.8% (79/346). The complication rate of the operation was 42.3% (9/21) during 1958-1976, 37.5% (6/16) during 1977-1987, 27.3% (6/22) during 1988-1998, and 10.0% (2/20) during 1998-2003. The perioperative mortality was 19.0% (4/21) during 1958-1976 (2 cases of pancreatic fistula and 1 case of liver and renal failure), 12.5% (2/16) during 1977-1987 (1 case of multiple organ failure and 1 case of bleeding), and 4.5% (1/22) during 1988-1998 (1 case of multiple organ failure). One patient with bile duct fistula during 1977-1987 and one patient with pancreatic fistula during 1988-1998 were cured by non-operative treatment. There was no perioperative death during 1999-2003. During the period of 1958-1976, the survival rate of patients undergoing PD was 55.5% by 1 year, 23.1% by 3 year, and 11.0% by 5 year. During 1977-1987, it was 56.3% by 1 year, 25.0% by 3 year, and 12.5% by 5 year. During 1988-1998, it was 59.1% by 1 year, 27.2% by 3 year, and 13.6% by 5 year.

CONCLUSIONSRemarkable improvement have been achieved in perioperative preparation and care after surgical treatment of pancreatic head cancer in the past decades. However, the resection rate and prognosis of PC were still poor, although the accuracy of early diagnosis is increasing, and the complications and perioperative mortality of PD are decreasing.