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KMID : 0371319760180100057
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Journal of the Korean Surgical Society
1976 Volume.18 No. 10 p.57 ~ p.67
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Periampullary Cancer and Whipple´s Operation
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金振勝/Kim, Chin Seung
朴正洙/李景植/金春奎/Park, Cheong Soo/Lee, Kyong Sik/Kim, Choon Kyu
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Abstract
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The periampullary cancer include carcinoma of the terminal bile duct, papilla of Vater and those carcinomas of the duodenum that are located near the ampulla of Vater. In most insta-nces, it is difficult to localize precisely the site of origin. Regardless of whatever their origin, those tumors produce a firm mass which tends to cause obstruction of the ampulla and most of the patients revealed jaundice.In the past the periampullary cancer include carcinoma in the head of pancreas also but it is different in pathophysiology from remainder and its posto-peative results was worse than the remainder, so at the present time, carcinoma in the head- of pancreas wasexcluded from the periampullary cancer. In the past, the diagnosis for periam-pullary cancer was very difficult and their operative risk was very high and their prognosis was worse than other tumors. At the present time, numerous diagnostic modalities such as hypotonic duodenography, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreaticography, exfoliative cytology during duodenoscopy, 75Se. pancreatic scanning, ultrasonography and selective pancreatic arteriography were introduced enhancing higher diagn-ostic accuracy. The operative experiences were now much increased and so the operative results became better than before. In our series, 22 cases of periampullary cancer, were treated with pancreaticoduodenectomy during the past 16 and half years from March 1959 to August 1976. The analysis of these cases provided the following results.
1. The most prevalent age group was the patients over 50 years old, 77% of patients were included in this age group, with female predominance.
About 82% of patients had jaundice at the time of admission and about 2/3 of patients complained weight loss. Abdominal mass was palpable in 59% of patients.
2. The most pertinent abnormal laboratory findings were increased serum bilirubin and alkaline phosphatase. (82%) and delayed prothrombin time. (32%)
U.G.I. series were performed in 20 cases and its diagnostic accuracy was only 50% and hypo-tonic duodenography was performed in 5 cases with 100% of diagnostic accuracy. P.T.C. and E. R. C. P: was performed in 2 cases each and their diagnostic accuracy were, 100%.
3. The resected specimen were carefully examined and final diagnosis was made after refer-ring microscopic findings. They were categorized as carcinoma in the ampulla of Vater 9 cases, carcinoma in the head of pancreas 8 cases, carcinoma in the second portion of the duodenum 3 cases and 2 cases were carcinoma in the terminal bile duct. The extent of metastasis was relatively wide comparing to other series. Local invasion was proved in 10 cases and omental invasion was found in 4 cases. Regional lymph node was negative in 4 cases only.
4. Major postoperative complications were 4 cases of postoperative bleeding, 3.cases of bile leaf and 2 cases of pancreatic leakage. Wound infection was most frequent complication and it was recorded in 8 cases. Only 5 patients were free from postoperative morbidity. The ope-rative mortality was higher before 1971 but in the recent 5 years, no operative mortality was recorded. According to the tumor location, no operative mortality was recorded in the carci-noma of ampulla of Vater and distal common bile duct carcinoma, but 4 out of 8 cases of head of pancreas cancer were died during hospitalization after surgery. Overall surgical mortality was 22.8%.
5. Postoperative survival rate in carcinoma of the pancreas head was poor. No one survived more than one year. Mean survival duration of duodenal cancer was 2 years and 10 months, and 2 years and 3 months in carcinoma of the ampulla of Vater, and 13 months in the distal common bile duct cancer.
Only one case of the ampulla of Vater carcinoma and also a case of the duodenal carcinoma survived more than 5 -years after surgery.
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