BACKGROUND: Periampullary cancer is referred to malignant tumor that occurs in pancreatic head, distal common bile duct, ampulla of Vater and duodenum according to anatomical position and poor prognosio he clinical symptoms, diagnosis and treatments are identical to positional characteristics. Since 1935, after Whipple originally described the removal of periampullary tumors, both the surgical method and the outcome associated with it have changed extensively. The mortality and morbidity rates associated with the procedure as performed today have decreased. (Objective) The authors evaluated the incidence, resectability and the clinical outcome of periampullary cancer. PATIENTS AND METHODS: We performed the clinical analysis retrospectively on 124 cases of periampullary cancer in the Department of Surgery and Internal medicine, School of Medicine, Wonkwang University from Oct. 1986 to July 1996. RESULTS: There were 77 men and 47 women and the male to female ratio was 1.64:1. The prevalent ages were in the 7th decade (44.4%), and 8th decade (27.4%). Fifty-four pancreatic head carcinomas(43.4%), 40 distal common bile duct carcinomas(32.3%), 28 Ampulla of Vater carcinomas( 22.6%), and 2 carcinomas of the periampullary duodenum(1.6%) were found. The major clinical symptoms and signs were abdominal pain (71%), jaundice (60.5%), and weight loss(33.1%). Resectability of pancreatic head cancer, distal common bile duct cancer, and ampulla of Vater cancer were 44.4%, 72.5%, and 85.7%, respectively. The mean resectability rate was 63.7%. The resection was performed in 60 cases ; Pylorus-preserving pancreaticoduodenectomy (29 cases), Whipple's operation (28 cases), total pancreatectomy (3 cases). The palliative procedure was performed in 14 cases ; gastrojejunostomy (6 cases), choledochotomy with T-tube drainage (5 cases), explolaparotomy with biopsy (4 cases). Postoperative mortality in resection surgery was 8.3%. Postoperative complication in resection surgery was 36.7%. The major causes of postoperative complications were wound complication( 16.7%) and respiratory complication(5.0%). The 1- year and 3-year survival rates after the resection were 47.1% and 22.0%, but those of nonresection group were 15.4% and 0%. The survival rate of resection group was significantly better than that of nonresection group (p<0.05). In the nonresection group, the 1-year survival rate in conservative treatment group including interventional procedure was 8.7% and 0% in palliative surgery group. Survival of nonoperable group was significantly better than that of palliative surgery group (p<0.05). According to anatomical tumor site, the 1-year and 3-year survival rates of pancreatic head cancer were 23.1%, 11.8%, and those of distal common bile duct cancer were 34.2%, 6.5%, and Ampulla of vater cancer 63.0%, 27.0%, respectively. SUMMARY: The pancreas head is the most common site of periampullary cancer. Survival of resection group and conservative treatment group is better than that of nonresection group and palliative surgery group, respectively.
Abdominal Pain ; Ampulla of Vater ; Biopsy ; Common Bile Duct ; Diagnosis ; Drainage ; Duodenum ; Female ; Gastric Bypass ; Head ; Head and Neck Neoplasms ; Humans ; Incidence ; Internal Medicine ; Jaundice ; Male ; Mortality ; Palliative Care ; Pancreas ; Pancreatectomy ; Pancreaticoduodenectomy ; Postoperative Complications ; Retrospective Studies ; Survival Rate ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Identification of coronary sites susceptible to progression or nonprogression might provide additional information to select medical or surgical treatment and furthermore for appropriate timing for percutaneous transluminal coronary angioplasty or coronary artery bypass graft. METHODS: We reviewed serial coronary arteriograms of 50 patients with coronary artery disease retrospectively. Patients were managed with standard treatment including anti-hypertensives, antiplatelets, lipid-lowering agents and other risk factor management by attending physician's decision. Patients who received percutaneous transluminal angioplasty, coronary artery bypass graft or thrombolysis were excluded. Cononary arteriographies were undertaken with average 33 months interval. Criteria for the progression and regression were the changes of the luminal diameter narrowing of the arterial segment by 20% or more reduction or increase, respectively. Results: Patients show progressive change, regressive change or no significant interval change in 50%, 12% and 30% of total 50 patients, respectively. Male gender, angiographic interval were the significant predictor of progressive change. In terms of coronary segment, stable segments are most frequent 52.2% (72/138) and progression in 40.2% (74/184), regression in 27.5% (38/138). Initial coronary lesions with low grade stenosis (less than 50%) have a tendency to progress than that of high grade stenosis (70% or more) Percentage diameter stenosis of new lesion are not related linearly with the interval between two sequential angiographies. CONCLUSION: Number of patients with progressive coronary arteriogram are more frequent than the patients with regressive change or no interval change. Progression and regression are frequent finding of serial coronary arteriography in usual clinical practice. Progression and regression are found frequently in the same patient at different coronary branches (16 patients). It suggested that the local factors may play an important role in the pathogenesis of coronary artery disease as well as systemic risk factors.
Angiography* ; Angioplasty ; Angioplasty, Balloon, Coronary ; Antihypertensive Agents ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Humans ; Male ; Phenobarbital ; Retrospective Studies ; Risk Factors ; Transplants