Pancreaticoduodenal resection for pancreatic or periampullary tumors--a ten-year experience.
Between January 1978, and December 1987, 79 patients underwent pancreaticoduodenal resection for pancreatic (44) or periampullary tumors (ampulla 18, common bile duct 9, duodenum 8). Fifty-five patients were icteric (55/79: 70%); 33 of them underwent preoperative biliary decompression (endoscopic procedures 29, percutaneous transhepatic drainage 3, laparotomy and T-tube placement. 1) After biliary drainage, bilirubin levels decreased from 12.4 +/- 1.3 mg/dl at admission to 5.1 +/- 1.1 mg/dl before surgery. Pancreaticoduodenal resection was performed within a mean of 15 +/- 13 days after biliary decompression. Twenty-seven patients had no complications, others developed one or more complications. The postoperative mortality was 5% (4/79). The influence of various clinical, biological and pathological factors on postoperative complications and long-term survival was studied. Neither jaundice nor preoperative biliary drainage had a statistically significant effect on overall morbidity and mortality. However, septic and hemorrhagic complications appeared to be more frequent with preoperative bilirubin levels above 20 mg/dl (0.05 less than P less than 0.1), while all postoperative pancreatic and biliary fistulas occurred in patients with a bilirubin level below 6 mg/dl (P less than 0.01). Biliary fistulas were also more frequent when anastomosis was performed on a non-dilated biliary duct (P less than 0.05). Overall actuarial survival was 58% at 1 year and 26% at 5 years. Node and/or contiguous tissue infiltration significantly decreased long-term survival (P less than 0.001). Seventy-one adenocarcinomas were reviewed and graded following a modified version of Klöppel's pathological classification.(ABSTRACT TRUNCATED AT 250 WORDS)
Ceuterick
M
M
Department of Digestive Surgery and Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Gelin
M
M
Rickaert
F
F
Van de Stadt
J
J
Devière
J
J
Cremer
M
M
Lambilliotte
J P
JP
D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D015996:Survival Rate