[Clinico-pathological characteristics of surgical effect on periampullary cancers: report of 631 cases]

Abstract

Objective: To analyze the differences and relationships among periampullary cancers.

Methods: A retrospective study was accomplished on the clinical manifestation, pathological behavior and postoperative survival of 631 patients with periampullary cancer hospitalized from Jan 1980 to Dec 2003.

Results: The characteristics of different periampullary cancers, in the order of carcinoma of head of pancreas (n = 352), carcinoma of common bile duct (n = 42), carcinoma of Vater's ampulla (n = 189), and duodenal cancer (n = 48) were as follows: (1) the mean duration of symptoms were 11.9 +/- 1.3, 5.8 +/- 0.9, 6.3 +/- 0.6, and 18.3 +/- 4.0 weeks (F = 6.18, P < 0.01); (2) the serum total bilirubin was 225 +/- 10, 345 +/- 35, 235 +/- 13, and 50 +/- 13 micromol/L(chi(2) = 68.49, P < 0.01); (3) the mean tumor size was 6.0 +/- 2.2, 3.0 +/- 1.3, 3.0 +/- 1.9, and 4.8 +/- 3.9 cm respectively (chi(2) = 255.7, P < 0.01); (4) adenocarcinoma accounted for 88%. Distant metastasis occurred in 98 cases, mostly to liver, abdominal cavity, and omentum. Local invasion mainly occurred in duodenum (chi(2) = 10.76, P < 0.01), common bile duct (chi(2) = 15.16, P < 0.01), and periampullary tissues (chi(2) = 22.49, P < 0.01), and great vessels (chi(2) = 51.25, P < 0.01). (5) the T staging (chi(2) = 11.68, P < 0.01) and lymph node status (chi(2) = 8.33, P < 0.05) of the removed tumor specimens were different among different kinds of carcinomas; (6) local invasion of duodenum (chi(2) = 10.76, P < 0.01), common bile duct (chi(2) = 15.16, P < 0.001), periampullary tissues (chi(2) = 22.49, P < 0.01), and great vessel (chi(2) = 51.25, P < 0.01) occurred in unresectable carcinomas; (7) the resection rates were 13% (n = 46), 50% (n = 21), 74% (n = 139), and 56% (n = 27) respectively (chi(2) = 205.6, P < 0.01); (8) the postoperative median survival periods were 6.0 +/- 0.3, 13.0 +/- 1.2, 22.0 +/- 1.6, and 13.0 +/- 2.5 months respectively (chi(2) = 173.47, P < 0.01).

Conclusion: Different tumor has its predominant clinical manifestation, pathological character, the probability of resection, and postoperative median survival. The prognosis after surgical treatment may be decided by biological behavior of tumor itself.