Palliative surgical bypass for unresectable periampullary carcinoma

BACKGROUND:Around 60%to 80%of patients with periampullary carcinoma are unresectable either due to distant metastasis or local vascular invasion.With the advancement of endoscopic interventional procedures,the role of surgical bypass has diminished.However,surgical bypass is still appropriate in patients with unresectable disease discovered at the time of surgery.This study was conducted to assess the results of palliative surgical bypass for patients with unresectable periampullary carcinoma at our hospital,a tertiary referral center of Northern India. METHOD:The study group comprised 204 patients who had undergone surgical bypass for advanced periampullary carcinoma over the last 15 years. RESULTS:Between January 1990 and December 2004,204 patients(128 males,76 females)consisting of 179 patients with carcinoma of head of the pancreas,14 patients with ampullary carcinoma,8 patients with lower end cholangiocarcinoma and 3 patients with duodenal carcinoma underwent surgical bypass.Their average age was 51 years (range 20-78 years).Both biliary and gastric bypasses were done in 158(77.45%),biliary bypass alone in 37(18.13%) and gastric bypass alone in 9(4.32%).Biliary bypass was done by Roux-en-Y hepaticojejunostomy,and gastric bypass by retrocolic gastrojejunostomy.The overall postoperative mortality and morbidity were 0.98%and 26.9%,respectively The patients who died had undergone previously endoscopic intervention.Complications included wound infection in 12.25%of the patients,bile leak in 5.12%,delayed gastric emptying in 5.38%,ascitic leak from drains in 8.8%,and upper gastrointestinal bleeding in 1.96%.The incidences of wound infection and bile leak both were significantly higher in patients who had had preoperative biliary stenting None of the patients who had undergone Roux-en-Y hepati cojejunostomy+retrocolic gastrojejunostomy required any intervention later in their life.CONCLUSIONS:Surgical bypass is a safe procedure with negligible mortality and minimal morbidity.It has not lost its relevance and is an appropriate treatment in patients deemed unresectable on peroperative assessment.

CLINICAL ANALYSIS OF 150 PATIENTS WITH PERIAMPULLARY CARCINOMA

This article report 150 cases of patients with periampullary carcinoma,of them,the tumors of 85 cases were in the head of pancreas,26 in lower part of the common bileduct,21 in ampulla of Vater and 18 in duodenal papilla.Of 150 patients,paucreatoduodenectomy were performed in 53 cases but one had total pancreactomy,with a total resection rate of 36%.respectability was high in ampulla and duodenal papilla cancers,with a resection rate of 89.5% and 83.3%,respectively.The lowest resection rate 14.1%,was in patients with cancer in bead of the pancreas.Twenty cases had postoperative complications,the morbidity rate was 13.3%.Postoperative death occurred in 9 cases with a mortality rate of 6%.The follow-up results showed that the 3-year and 5-year survival rates of the resection group were 31.8% and 11.8% respectively.Fifty-four cases with resec-tions had a mean survival period of 16.7 months.Ampullary cartinoma group had the longest survival period,22.4 mouths,but non-resection group,all had bileinbestinal shunt only 4.8 mouths.

Clinical efficacy of total three-dimensional laparoscopic pancreatoduodenectomy

Objective To investigate the feasibility and clinical efficacy of total three-dimensional laparoscopic pancreatoduodenectomy. Methods The clinical data of 28 patients who underwent total three-dimensional laparoscopic pancreatoduodenectomy at the Second Hospital of Hebei Medical University from August 2015 to May 2016 were retrospectively analyzed. The surgical indications and method of performing total threedimensional laparoscopic pancreatoduodenectomy were similar to those of the patients who underwent two-dimensional laparoscopic pancreatoduodenectomy. All of the patients were followed up via outpatient reviews and telephone interviews through September 2016. Results In all 28 cases, total three-dimensional laparoscopic pancreatoduodenectomy was successfully performed with no conversion to laparotomy, intraoperative complications, or perioperative death. The mean operative time was 406 min(200–520 min) with a mean blood loss of 528 m L(200–1500 m L), a mean number of dissected lymph nodes of 11(6–16), a mean postoperative anus exhaust time of 4.4 d(2–8 d), and a mean length of stay of 16.9 d(9–23 d). There was a postoperative pancreatic fistula in 4 out of the 28 cases, with 3 cases of grade A and 1 case of grade B. Postoperatively, one patient with early-stage intra-abdominal hemorrhage improved after conservative symptomatic treatment, and two patients with gastroplegia were cured with conservative treatment. No complications occurred in the other patients. All of the cases underwent R0 resection with a negative surgical margin. All of the 28 patients were followed up for 6 to 12 months, with a median follow-up period of 9.2 months. During the follow-up period, there were no postoperative complications related to the procedures and no deaths; tumor recurrence was identified 9 months after the procedure using positron emission computed tomography(PECT) in one patient with pancreatic ductal adenocarcinoma.Conclusion Total three-dimensional laparoscopic pancreatoduodenectomy is safe and feasible for the treatment of periampullary carcinoma, with the advantage of favorable short-term outcomes.