title: Palliative pancreaticoduodenectomy in pancreatic and periampullary adenocarcinomas.
abstract: OBJECTIVE
  The objective of the study was to clarify the role of a palliative pancreaticoduodenectomy in both pancreatic and periampullary adenocarcinomas.
  
  
  METHODS
  Survival outcomes were compared between resections and bypass operations, and between curative (R0) and palliative resections, with a microscopically (R1) and a grossly (R2) positive resection margin.
  
  
  RESULTS
  There were 595 surgical patients, including 207 undergoing bypass operations and 388 undergoing pancreaticoduodenectomies, with 47.4% curative resections (R0) and 17.8% palliative resections (R1 + R2). The overall positive margin rate after a pancreaticoduodenectomy was 27.3% (R1 = 8.0%, R2 = 19.3%). For periampullary adenocarcinomas, there was a significant survival difference between the R0, palliative, and no resection groups. However, there was no significant survival difference between the R0 and palliative resection for pancreatic head adenocarcinoma. Note that the survival outcome after either a curative or a palliative pancreaticoduodenectomy was still better than the survival outcome of a bypass operation.
  
  
  CONCLUSIONS
  There was a survival benefit after a pancreaticoduodenectomy regardless of the resection margin or primary origin of the periampullary adenocarcinoma, as compared with a bypass operation. The resection margin after a pancreaticoduodenectomy did not play a role in the survival outcome in pancreatic head adenocarcinoma. Therefore, we recommend that pancreaticoduodenectomies should be attempted whenever possible.
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shin-E
authors.initials: SE
authors.lastname: Wang
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Shyr
authors.forename: Cheng-Hsi
authors.initials: CH
authors.lastname: Su
authors.forename: Tien-Hua
authors.initials: TH
authors.lastname: Chen
authors.forename: Chew-Wun
authors.initials: CW
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome