Scientific paperFactors influencing survival after resection for periampullary neoplasms
Section snippets
Patients and methods
A retrospective review of 208 patients undergoing laparotomy for presumed periampullary neoplasia at a single institution between 1983 and 1998 was carried out. Patients undergoing laparotomy for pancreatitis were excluded from the study. Charts were reviewed for patient demographics, operative, and pathologic parameters and follow-up data were obtained from tumor registry and/or clinic notes. All cases were done with residents at a teaching institution under the supervision of one attending
Patient demographics and operative variables
The patients had a median age of 63 years (range 29 to 90); 58% of patients were male and 78% were white. Of the 208 patients who underwent laparotomy for presumed periampullary carcinoma, 79 were found to be unresectable and underwent palliative bypass or biopsy only. The remaining 129 patients underwent pancreatic resection consisting of the Whipple procedure in 71 (55%), total pancreatectomy in 35 (27%), distal pancreatectomy in 21 (16%), and partial pancreatectomy in 2 (1%). The median
Comments
We have used the term “periampullary” with the full acknowledgement that it covers a wide array of histologic tumor types from several adjoining anatomic structures. The justification for the continued usage of the term is explained in Table I. The exact tumor type and site of origin cannot often be detected preoperatively and even intraoperatively. The full answer is often obtained only after careful pathologic examination of the resected specimen. Thus, only about 75% of periampullary cancers
Conclusion
In summary, although many patients with periampullary neoplasms succumb to their disease, there is a subset of patients who will do well after pancreatectomy. These patients include those with well-differentiated histology, small tumors, negative nodes, clear margins, absence of vascular or perineural invasion, and ampullary or distal common bile duct tumors. Clearly, the most important chance to affect survival remains with earlier detection. The possibilities for earlier detection of
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