Clinical analysis of periampullary cancer

Yang, Ki Young; Chae, Kwon Mook; So, Byung Jun; Kim, Jae Hyung; Kim, Hak cheoul

Abstract

BACKGROUND: Periampullary cancer is referred to malignant tumor that occurs in pancreatic head, distal common bile duct, ampulla of Vater and duodenum according to anatomical position and poor prognosio he clinical symptoms, diagnosis and treatments are identical to positional characteristics. Since 1935, after Whipple originally described the removal of periampullary tumors, both the surgical method and the outcome associated with it have changed extensively. The mortality and morbidity rates associated with the procedure as performed today have decreased. (Objective) The authors evaluated the incidence, resectability and the clinical outcome of periampullary cancer.
PATIENTS AND METHODS
We performed the clinical analysis retrospectively on 124 cases of periampullary cancer in the Department of Surgery and Internal medicine, School of Medicine, Wonkwang University from Oct. 1986 to July 1996.
RESULTS
There were 77 men and 47 women and the male to female ratio was 1.64:1. The prevalent ages were in the 7th decade (44.4%), and 8th decade (27.4%). Fifty-four pancreatic head carcinomas(43.4%), 40 distal common bile duct carcinomas(32.3%), 28 Ampulla of Vater carcinomas( 22.6%), and 2 carcinomas of the periampullary duodenum(1.6%) were found. The major clinical symptoms and signs were abdominal pain (71%), jaundice (60.5%), and weight loss(33.1%). Resectability of pancreatic head cancer, distal common bile duct cancer, and ampulla of Vater cancer were 44.4%, 72.5%, and 85.7%, respectively. The mean resectability rate was 63.7%. The resection was performed in 60 cases ; Pylorus-preserving pancreaticoduodenectomy (29 cases), Whipple's operation (28 cases), total pancreatectomy (3 cases). The palliative procedure was performed in 14 cases ; gastrojejunostomy (6 cases), choledochotomy with T-tube drainage (5 cases), explolaparotomy with biopsy (4 cases). Postoperative mortality in resection surgery was 8.3%. Postoperative complication in resection surgery was 36.7%. The major causes of postoperative complications were wound complication( 16.7%) and respiratory complication(5.0%). The 1- year and 3-year survival rates after the resection were 47.1% and 22.0%, but those of nonresection group were 15.4% and 0%. The survival rate of resection group was significantly better than that of nonresection group (p<0.05). In the nonresection group, the 1-year survival rate in conservative treatment group including interventional procedure was 8.7% and 0% in palliative surgery group. Survival of nonoperable group was significantly better than that of palliative surgery group (p<0.05). According to anatomical tumor site, the 1-year and 3-year survival rates of pancreatic head cancer were 23.1%, 11.8%, and those of distal common bile duct cancer were 34.2%, 6.5%, and Ampulla of vater cancer 63.0%, 27.0%, respectively. SUMMARY: The pancreas head is the most common site of periampullary cancer. Survival of resection group and conservative treatment group is better than that of nonresection group and palliative surgery group, respectively.