title: A scoring system for preoperative assessment of resectability in periampullary neoplasms.
abstract: BACKGROUND
  To identify the preoperative factors predicting resectability in periampullary neoplasms.
  
  
  METHODS
  Twenty-three different parameters representing the clinical, laboratory and radiological data of 65 patients, who were operated for periampullary neoplasms, were analyzed to determine their value in assessing neoplasm resectability. Coefficients were calculated by Cox regression analysis for significant factors. A scoring system was designed for resectability. All patients were divided into 4 groups according to their scores.
  
  
  RESULTS
  Twenty-six patients who had a resectable neoplasm underwent pancreatico-duodenectomy and surgical palliation was performed in the remaining 39 patients. After multivariate analysis, neoplasms larger than 4.5 cm, low leukocyte count (<9500/mm3), high bilirubin levels (>137.5 micromol/L) and tomographic findings indicating neoplasm invasion were found to be independent factors predicting resectability. The score range was between 0 and 12. Patients were grouped as Group-1 (total score 0-2), Group-2 (total score 3-5), Group-3 (total score 6-8), and Group-4 (total score 9 and higher). Resectability rates were 100% in Group 1 (n=13), 44% in Group-2 (n=23), 21% in Group-3 (n=14), and 0% in Group-4 (n=15), respectively. Mean score was 3.3 in patients with resectable lesions and 7.2 in patients with unresectable lesions (p<0.001).
  
  
  CONCLUSIONS
  This simple scoring system can be a guide in the management plans of patients with periampullary neoplasms. By using this scoring system, patients with an unresectable neoplasm can be predicted and most unnecessary laparotomies can be avoided (Tab. 3, Fig. 2, Ref. 27). Full Text (Free, PDF) www.bmj.sk.
authors.affiliation: Ankara Numune Education and Research Hospital, 4th Department of Surgery, Ankara, Turkey. ynyuksek@yahoo.com
authors.forename: Yunus Nadi
authors.initials: YN
authors.lastname: Yuksek
authors.forename: Gul
authors.initials: G
authors.lastname: Daglar
authors.forename: Ugur
authors.initials: U
authors.lastname: Gozalan
authors.forename: Tanju
authors.initials: T
authors.lastname: Tutuncu
authors.forename: Mutlu
authors.initials: M
authors.lastname: Doganay
authors.forename: Nuri Aydin
authors.initials: NA
authors.lastname: Kama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy