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 is poor prognostic tumor to dealt with similar because the clinical
symptoms,
diagnosis and treatments are identical to positional characteristics. Although the resection of periampullary cancer has been transformed by many surgeons until the present time after Whipple performed the resection of tumor for the first time in
1935,
it is as yet known to the operation which complication and mortality are high. As being diagnosed early owing to high recognition about cancer and the development of variable diagnostic methods, we have been concerned in periampullary cancer as
the
frequency of pancreatoduodenectomy is increased.
We performed the clinical analysis retrospectively in 123 cases of periampullary cancer at the Department of Surgery, Catholic University Medical College, Kangnam St. Mary's Hospital during the past 11 years from Jan. 1982 to Dec.
@ES 1992 and the results were as follows:
@EN 1) There were 73 men(59%) and 50 woment(41%) respectively and the male and female ratio was 1.4 : 1. The prevalent age was 6th decade(34%), 5th decade(31%) and it was over half of the number.
2. the major clinical symptoms were abdominal pain(80%), Jaundice (70%), weight loss(48%). Indlgestion(45%). In laboratory findings, the incidence of increased level of alkaline phosphatase was highest(77%) and that of jaundice(73%), increased
level of
liver enzyme(54%) was next.
3. Pancreas head is the most common site(59%) of periampullary cancer followed by ampulla of Vater(20%) distal common bile duct(16.2%) and duodenal cancer(94.2%) in decreasing order of frequence. The resection rate of periampullary cancer was
47%(ampulla of Vater cancer : 88%, duodenal cancer: 80%, distal common bile duct cancer: 66.6 & pancreas head cancer : 25%).
4. The mortality was 2% in resection and 8% in bypass surgery due to sepsis and bleeding. Postoperative complication was 43% in resection and 46% in bypass surgery. Ther major cause of postoperative complication were bleeding and anastomotic
leakage.
5. The 1 year, 4 year, 3 year, 5 year survival rate after the resection of pancreatic head cancer were 41%, 22%, 15%, 7% and those of distal common bile duct cancer were 85%, 47%, 28, 14% and ampulla of Vater cancer were 78%, 71%, 47%, 38%
respectively. In the pancreatic head cancer, the survival rate of resection was significantly better than that of bypass surgery but there is no difference aong bypass methods. The factors of influencing survival rate were the stage of tumor and
presence of lymph node metastasis, but existence and presence of chemotherapy, radiotherapy and cell differentiation did not influence to the survival rate.
6. In the case of bypass surgery, survival of internal drainage procedure was better than T-tube drainage procedure. Survival rate among anatomical disease was no difference and among them, survival rate according to bypass method was also no
difference.
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