title: Surgical management of peri-ampullary tumors: a retrospective study.
abstract: OBJECTIVE
  Surgical resection still remains the best treatment for patients with periampullary tumors. This study aims to present the results of surgical treatment of this disease at our center.
  
  
  METHODS
  Between January 1995 and December 2004, 216 periampullary tumors were treated by surgical resection. The mean age was 58 years with male to female ratio 2:1. The most common symptom was jaundice (97.7%). Abdominal pain occurred in 74% of patients. Pancreaticogastrostomy was done in 183 patients and pancreaticojejunostomy in 33 patients.
  
  
  RESULTS
  Operative mortality occurred in 7 patients (3.2%). The median survival was 22.6 months for patients with ampullary tumors and 16.6 months for patients with pancreatic head tumors. Early operative complications occurred in 33% of patients; the most common one was wound infection (11.6%), pancreatic leak (10.6%), abdominal collection (10.6%) and delayed gastric emptying (8.8%). Factors associated with increased risk of developing complications were the type of pancreatico-enteric anastomosis (pancreatic leak was more frequent with pancraticojejunostomy), soft pancreatic texture and intraoperative blood transfusion of more than 4 units. Factors associated with better survival included tumor diameter (less than 3cm), origin (ampullary), differentiation (well differentiated) and margin status (negative resection margins).
  
  
  CONCLUSIONS
  Postoperative complications of pancreaticoduodenectomy, especially with the adoption of pancreaticogastrostomy, occur with reasonable incidence. Survival largely depends on the origin of the tumor.
authors.affiliation: Gastroenterology Center, Mansoura University, Egypt. o_fathy@mans.edu.eg
authors.forename: O
authors.initials: O
authors.lastname: Fathy
authors.forename: M
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: N
authors.initials: N
authors.lastname: Elghwalby
authors.forename: A
authors.initials: A
authors.lastname: Sultan
authors.forename: G
authors.initials: G
authors.lastname: El-Ebidy
authors.forename: M
authors.initials: M
authors.lastname: Abu-Zeid
authors.forename: T
authors.initials: T
authors.lastname: Abd-Allah
authors.forename: M
authors.initials: M
authors.lastname: El-Shobary
authors.forename: A
authors.initials: A
authors.lastname: Fouad
authors.forename: Th
authors.initials: T
authors.lastname: Kandeel
authors.forename: A
authors.initials: A
authors.lastname: Abo-Elenien
authors.forename: N Gad
authors.initials: NG
authors.lastname: El-Hah
authors.forename: A
authors.initials: A
authors.lastname: Abdel-Raouf
authors.forename: A M
authors.initials: AM
authors.lastname: Sultan
authors.forename: Farouk
authors.initials: F
authors.lastname: Ezzat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014670:Ampulla of Vater; D002648:Child; D015331:Cohort Studies; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult