Criteria for Pylorus Preserving Pancreaticoduodenectomy in Patients with Periampullary Carcinoma

Histopathological Study on 245 Surgically Resected Cases

Abstract

Two hundreds and fourty-five patients who underwent pancreaticoduodenectomy for periampullary carcinoma were studied pathologically to determine the criteria for pylorus preserving pancreaticoduodenectomy. Among the 245 patients, carcinoma of the head of the pancreas was the indication for operation in 106, ampulla Vater in 54, middle and distal bile duct in 40, gallbladder in 38, and duodenum in 7. The patients were divided into different group with regard to positive lymph node metastasis in one of No group with regard to positive lymph node metastasis in one of No (3), (4), (5), (6), or (7) (N-meta factor) and direct tumor infiltration into the stomach or the first portion of the duodenum (D-inf factor). In patients with carcinoma of the ampulla Vater, percentage of the patients having positive N-meta factor was 0%, and percentage of the patients having positive N-meta factor was only 3.7%. In patients with carcinoma of the middle and distal bile duct, gallbladder, or duodenum, all patients with negative D-inf factor showed negative N-meta factor. In patients with carcinoma of to head of the pancreas, however, percentage with carcinoma of the head of the pancreas, however, percentage of the patients with negative D-inf factor and positive N-meta factor was 7.5%. 1. These results suggest that pylorus preserving pancreaticoduodenectomy is the choice of the operation in patients with carcinoma of the ampulla Vater. 2. This operation is also the choice of treatment in patients with carcinoma of the middle and distal bile duct, gallbladder, or duodenum, if those patients had negative D-inf factor. 3. Whipple's operation should be done for patients with carcinoma of the head of the pancreas as far as radical operation is concerned.