Periampullary carcinomas: a special entity of duodenal tumors.

DEFINITION

Periampullary carcinomas are rare and constitute a special entity, as diagnosed earlier and having a better prognosis than other duodenal tumors.

METHODS

In the present study, we retrospectively reviewed the medical records of 16 patients with periampullary carcinomas over 10 years.

RESULTS

16 patients, 10 men and 6 women (median age 66.7 years, range 42-80) had a malignant periampullary tumor. Initial symptoms were jaundice (88%), weight loss (69%), nausea and vomiting (50%) and abdominal pain (38%). Gastro-duodenoscopy, ERCP, ultrasound and CT scan were the most useful diagnostic tools. Histologically all the tumors were adenocarcinomas and solitary tumors. 91% were stage pT1 or pT2 tumors, localized in the duodenal wall without any infiltration of the pancreas. 36% of the tumors had metastasized either in lymph nodes or distant organs at diagnosis (18% pN1, 18% pM1). Resectability rate was 81%, curative resection was achieved in 62%. The operations performed were pancreatico-duodenectomy (n = 8), local tumor resection (n = 5) and palliative bypass (n = 3). Morbidity and reoperation rate were 37.5% and 18.8%, respectively; 30-day mortality was 0%. The 1- and 5-year survival rates were 58.3% and 33.3%, respectively.

CONCLUSIONS

Compared to carcinomas of the small bowel or the exocrine pancreas periampullary carcinomas have a far better 5-year survival rate of more than 30%. Aggressive diagnostic workup in case of the leading symptom jaundice and radical operative therapy are key factors to achieve this goal.