1.Expression of Cyclooxygenase-2 and Its Correlation with Clinicopathologic Factors of Ampulla of Vater Cancer.
Hong Joo KIM ; Tae Sung SOHN ; Kyu Taek LEE ; Jong Kyun LEE ; Seung Woon PAIK ; Jong Chul RHEE
Journal of Korean Medical Science 2003;18(2):218-224
There has been no report for the expression of cyclooxygenase-2 (COX-2) and its clinicopathologic and biologic significance in ampulla of Vater cancer. This study was aimed for the clarification of COX-2 expression and its biologic roles in ampulla of Vater cancer. Fourty-six patients with ampulla of Vater cancer were enrolled and their COX-2 expression and clinicopathologic features were analyzed. The median age of patients was 60 yr and the mean duration of follow-up was 35 months (range: 14-82 months). Immunohistochemical stainings for COX-2, Ki-67, CD34 and TUNEL staining were performed. The immunoreactive COX-2 expression was present in 24 (52.2%) patients of ampulla of Vater cancer and mainly localized in cytosolic and perinuclear region. There was no significant difference in the length of survival between COX-2 postive and negative group (p=0.9420 by Log Rank test). Also, there were no significant differences of proliferation index (p=0.326), apoptotic index (p=0.764) and microvessel density (p=0.135) between COX-2 positive and negative group. Initial pTNM stage (p=0.0028 by Log Rank test) and blood transfusion over 4 pints during operation (p=0.0254 by Log Rank test) were independent prognostic factor in patients with ampulla of Vater cancer. It is suggested that immunoreactivity of COX-2 is not correlated with clinicopathologic and biologic features of ampulla of Vater cancer.
Adult
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Aged
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Ampulla of Vater*/enzymology
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Ampulla of Vater*/pathology
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Common Bile Duct Neoplasms/enzymology*
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Common Bile Duct Neoplasms/pathology*
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Female
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Human
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Immunoenzyme Techniques
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Isoenzymes/metabolism*
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Male
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Middle Aged
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Prostaglandin-Endoperoxide Synthase/metabolism*
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Statistics
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Survival Rate
2.Expression of Hedgehog Proteins in Periampullary Cancer.
Sun Young LEE ; Kyu Taek LEE ; Kee Taek JANG ; Seong Ho CHOI ; Jin Seok HEO ; Dong Hee KIM ; Jong Kyun LEE ; Seung Woon PAIK ; Jong Chul RHEE
The Korean Journal of Gastroenterology 2005;46(4):291-296
BACKGROUND/AIMS: Hedgehog protein is an essential molecule for gastrointestinal tract development, and disruption of hedgehog signaling pathway is linked to some gastrointestinal tumorigenesis. Here, we performed hedgehog immunostaining in periampullary cancer to evaluate the differences according to the location type of cancer and the differentiation of adenocarcinoma. METHODS: We retrieved surgical specimens from 43 periampullary cancer patients (15 ampulla of Vater cancer, 12 distal common bile duct cancer, 13 pancreatic head cancer, and 3 combined ampulla of Vater/bile duct cancer). Immunohistochemical stain was performed in both normal and cancerous tissue portions of each case using Sonic hedgehog (H-160) rabbit polyclonal antibody. Immunohistochemical stain results were grouped into three groups according to the percentage of positive cytoplasmic stain in tumor volume (unstained: <5%, weakly stained: 5-50%, and strongly stained: >50%). RESULTS: All of the normal tissue revealed negative immunohistochemical stain while cancerous tissue revealed positivity in 95.3% (41/43 cases). Strongly stained cases were more frequently seen in ampulla of Vater cancers (13/15) and in combined ampulla of Vater/bile duct cancers (3/3) than in distal common bile duct cancers (4/12) and in pancreatic head cancers (3/13) (p=0.002). In addition, strongly stained cases were more frequently seen in well-differentiated adenocarcinoma than the others (p<0.001). CONCLUSIONS: Most of the periampullary cancers show hedgehog protein expression. In addition, hedgehog protein immunostainings shows stronger expression in ampulla of Vater cancers and in well-differentiated adenocarcinoma.
Adenocarcinoma/metabolism
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Aged
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*Ampulla of Vater
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Common Bile Duct Neoplasms/*metabolism
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English Abstract
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Female
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Humans
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Immunohistochemistry
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Male
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Middle Aged
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Pancreatic Neoplasms/*metabolism
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Trans-Activators/*metabolism
3.Differential Expression of E-Cadherin, beta-Catenin, and S100A4 in Intestinal Type and Nonintestinal Type Ampulla of Vater Cancers.
Rohyun SUNG ; Li KANG ; Joung Ho HAN ; Jae Woon CHOI ; Sang Hwa LEE ; Tae Hoon LEE ; Sang Heum PARK ; Hong Ja KIM ; Eaum Seok LEE ; Young Suk KIM ; Young Woo CHOI ; Seon Mee PARK
Gut and Liver 2014;8(1):94-101
BACKGROUND/AIMS: Epithelial-mesenchymal transition (EMT)-related proteins may exhibit differential expression in intestinal type or pancreatobiliary type ampulla of Vater carcinomas (AVCs). We evaluated the expression of E-cadherin, beta-catenin, and S100A4 in intestinal and nonintestinal type AVCs and analyzed their relationships with clinicopathological variables and survival. METHODS: A clinicopathological review of 105 patients with AVCs and immunohistochemical staining for E-cadherin, beta-catenin, and S100A4 were performed. The association between clinicopathological parameters, histological type, and expression of EMT proteins and their effects on survival were analyzed. RESULTS: Sixty-five intestinal type, 35 pancreatobiliary type, and five other types of AVCs were identified. The severity of EMT changes differed between the AVC types; membranous loss of E-cadherin and beta-catenin was observed in nonintestinal type tumors, whereas aberrant nonmembranous beta-catenin expression was observed in intestinal type tumors. EMT-related changes were more pronounced in the invasive tumor margin than in the tumor center, and these EMT-related changes were related to tumor aggressiveness. Among the clinicopathological parameters, a desmoplastic reaction was related to overall survival, and the reaction was more severe in nonintestinal type than in intestinal type AVCs. CONCLUSIONS: Dysregulation of E-cadherin, beta-cadherin, and S100A4 expression may play a role in the carcinogenesis and tumor progression of AVCs.
Aged
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Aged, 80 and over
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Ampulla of Vater/*metabolism
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Cadherins/metabolism
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Common Bile Duct Neoplasms/classification/*metabolism
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Disease-Free Survival
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Female
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Humans
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Male
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Middle Aged
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Prognosis
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Retrospective Studies
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S100 Proteins/metabolism
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Tumor Markers, Biological/*metabolism
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beta Catenin/metabolism
4.Hepatoid adenocarcinoma of duodenal papilla: report of a case.
Jian-ming WENG ; Wen-qiao WU ; Quan-yuan LIU
Chinese Journal of Pathology 2009;38(7):494-494
Adenocarcinoma
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metabolism
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pathology
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Aged
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Ampulla of Vater
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pathology
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Carcinoid Tumor
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pathology
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Carcinoma, Hepatocellular
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metabolism
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pathology
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Diagnosis, Differential
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Duodenal Neoplasms
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metabolism
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pathology
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Endodermal Sinus Tumor
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pathology
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Humans
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Male
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alpha-Fetoproteins
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metabolism
5.Prognostic Significance of Angiogenesis by Chalkley Counting in Node Negative Cancer of the Ampulla of Vater.
Joon Seong PARK ; Hyun Ki KIM ; Soon Won HONG ; Jae Keun KIM ; Dong Sup YOON
Journal of Korean Medical Science 2012;27(5):495-499
Angiogenesis is essential for tumor growth and metastasis. Currently, the Chalkley assay with CD34 immunostaining is the proposed standard method for angiogenesis quantification in solid tumor sections. The purpose of this study was to evaluate the expression of CD34 and its prognostic significance using the Chalkley method in node negative carcinoma of the ampulla of Vater. Between January 1997 and December 2006, 56 node negative patients who had curative resection for carcinoma of the ampulla of Vater were retrospectively reviewed. The Chalkley count was expressed as the mean value of the three counts for each tumor and further divided into two groups according to the mean value of the Chalkley count: low < 4 or high > or = 4. The mean Chalkley count value was 4.0 (+/- 3.1). In the low Chalkley group, the 1- and 3-yr recurrence rates were 18.3%, 47.6% respectively; in the high Chalkley group, the 1- and 3-yr recurrence rates were 26.5% and 60.6% respectively. Only high Chalkley count had statistical significance as a factor in recurrence of node negative ampulla of Vater carcinoma. Assessment of angiogenesis may have an important role in the prognostic evaluation of node negative cancer of the ampulla of Vater.
Adult
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Aged
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Ampulla of Vater/metabolism/*pathology
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Antigens, CD34/metabolism
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Carcinoma/metabolism/mortality/*pathology
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Common Bile Duct Neoplasms/metabolism/mortality/*pathology
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Disease-Free Survival
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Female
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Humans
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Lymphatic Metastasis
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Male
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Middle Aged
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*Neovascularization, Pathologic
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Predictive Value of Tests
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Prognosis
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Recurrence
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Retrospective Studies
6.Endoscopic Resection as a Possible Radical Treatment for Duodenal Gangliocytic Paraganglioma: A Report of Four Cases.
Se Jeong PARK ; Do Hoon KIM ; Hyun LIM ; Jeong Hoon LEE ; Kee Don CHOI ; Ho June SONG ; Gin Hyug LEE ; Hwoon Yong JUNG ; Jin Ho KIM ; Ji Young PARK
The Korean Journal of Gastroenterology 2014;63(2):114-119
Gangliocytic paraganglioma (GP) is a rare, benign tumor which is usually found in the duodenum. We here report four recent cases of GP, with successful endoscopic resection in three cases, including a lesion on the ampulla of Vater. In all cases, each lesion had a stalk that facilitated removal using an endoscopic approach. Endoscopic mucosal resection is a feasible and safe treatment if the location, depth, and lymph node status are all favorable and is also helpful for definite diagnosis of unknown duodenal mass. To avoid morbidity resulting from open surgical resection, careful inspection for the peduncle of the GP will help determine the feasibility of endoscopic resection.
Aged
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Ampulla of Vater/pathology
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Chromogranin A/metabolism
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Colonoscopy
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Duodenal Neoplasms/pathology/*surgery
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Endoscopy, Gastrointestinal
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Female
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Humans
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Immunohistochemistry
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Intestinal Mucosa/pathology/surgery
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Male
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Middle Aged
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Neuroendocrine Tumors/pathology/surgery
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Paraganglioma/pathology/*surgery
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S100 Proteins/metabolism
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Synaptophysin/metabolism
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Tomography, X-Ray Computed
7.Clinical, Pathological, and Immunohistochemical Features of Adenomyoma in the Ampulla of Vater.
Yong Hyeok CHOI ; Mi Jin KIM ; Joung Ho HAN ; Soon Man YOON ; Hee Bok CHAE ; Sei Jin YOUN ; Min Ho KANG ; Rohyun SUNG ; Jae Woon CHOI ; Seon Mee PARK
The Korean Journal of Gastroenterology 2013;62(6):352-358
BACKGROUND/AIMS: Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery. This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater. METHODS: Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), alpha-smooth muscle actin (alpha-SMA), and Ki-67 antigen were performed. RESULTS: All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of alpha-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions. CONCLUSIONS: Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas.
Actins/metabolism
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Adenomyoma/*pathology/surgery
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Aged
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Ampulla of Vater/*pathology
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Cholangiopancreatography, Endoscopic Retrograde
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Common Bile Duct Neoplasms/*pathology/surgery
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Female
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Humans
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Immunohistochemistry
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Keratin-20/metabolism
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Keratin-7/metabolism
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Ki-67 Antigen/metabolism
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Male
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Middle Aged
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Retrospective Studies
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Tomography, X-Ray Computed
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Treatment Outcome
8.Analysis of risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy.
Jian-wei ZHANG ; Hong ZHAO ; Xiao-feng BAI ; Yi FANG ; Chen-feng WANG ; Ping ZHAO
Chinese Journal of Oncology 2010;32(1):40-43
OBJECTIVETo assess the risk factors of stress-related ulcer and gastrointestinal hemorrhage after pancreaticoduodenectomy.
METHODSFrom May 1999 to July 2007, 285 periampullary cancer patients underwent pancreaticoduodenectomy in our hospital. The clinical data, pathological results, type of operation, and postoperative treatment were retrospectively analyzed. Patients with stress-related ulcer and gastrointestinal hemorrhage were selected for risk factor analysis, and other patients were taken as control group.
RESULTS35 patients (12.3%) developed stress-related ulcer and gastrointestinal hemorrhage following pancreaticoduodenectomy. Pathological examination showed pancreatic cancer in 5 cases, duodenal cancer in 8, common bile duct cancer in 10, ampullary carcinoma in 11, and solid-pseudopapillary tumors in 1. Single variate analysis demonstrated that alcohol, preoperative bilirubin level, operation time, lymph node metastasis, prealbumin decrease after operation and other complication were significantly associated with the stress-related ulcer and gastrointestinal hemorrhage. Logistic regression in multivariate analysis revealed that preoperative bilirubin level, operation time, other complication, prealbumin decrease after surgery were independent risk factors.
CONCLUSIONStress-related ulcer and gastrointestinal hemorrhage are one of the most common complications after pancreaticoduodenectomy. Preoperative bilirubin level, operation time, other complications, and prealbumin decrease after operation are four independently risk factors.
Adolescent ; Adult ; Aged ; Alcoholism ; complications ; Ampulla of Vater ; Bilirubin ; blood ; Common Bile Duct Neoplasms ; complications ; pathology ; surgery ; Duodenal Neoplasms ; complications ; pathology ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatic Neoplasms ; complications ; pathology ; surgery ; Pancreaticoduodenectomy ; adverse effects ; Peptic Ulcer ; etiology ; Prealbumin ; metabolism ; Retrospective Studies ; Risk Factors ; Stress, Psychological ; complications ; Young Adult