Authors evaluated 55 patients with periampullary cancer who underwent radical pancreaticoduodenectomy from January 1985 to December 1991 at the Department of Surgery, Korea Cancer Center Hospital and the results were as follows.
Fifty-five patients underwent pancreaticoduodenectomy among 129 surgically confirmed periampullary cancer patients. The most common site of the lesion was pancreatic head followed by ampulla of Vater, distal common bile duct and duodenum. The
overall
resection rate was 46.2% and resectability was highest in cancer of ampulla of Vater(94.4%) and lowest in pancreatic head cancer(26.9%).
The morbidity rate was 25.5%(14/55) and the major frequent postoperative complications were hemorrhage, leakage of anastomotic site, pneumonia, intraadbdominal abscess, renal failure, and sepsis. Operative mortality rate was 1.8%(1/55).
In prognostic factors affecting survival rate, a major determinant of survival was the site of origin of tumor and the others were regional lymph node status and intraoperative blood transfusion requirements(p<0.05).
Five year survival rate of curative resected group(25.9%) was higher than that of palliative group(0.0%)(p<0.05). One, three and five year survival rate of curative resected patients were 77.8%, 50.0% and 25.9% respectively. Resectable cancers of
ampulla of Vater, duodenum and distal common bile duct were associated with five year survival rates of 47.1%, 40.0% and 16.7% respectively, whereas five year survival rate of resectable pancreatic head cancer was 10.0%.
These results suggest that standard procedure for the periampullary cancer is radical pancreaticoduodenectomy in favor of longer survival and improved safety. Reduction of intraoperative blood transfusion requirement is needed to decrease
morbidity
and
to increase survival rates.
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