Retrospective review of 475 patients suffering from periampullary
carcinoma in intervals 1958 approximately 1976, 1977 approximately 1987, 1988 approximately 1998 and 1999 approximately 2003 is presented.
RESULTS: In interval 1958 approximately 1976, for 128 patients, the
tumor resection rate was:
pancreatic carcinoma (PC) 26.6% (21/79), ampullary
carcinoma (AC) 86.2% (25/29), distal
bile duct cancer (
DBDC) 38.5% (5/13), and
duodenal cancer (DC) 57.1% (4/7). In interval 1977 approximately 1987, for 70 patients, the
tumor resection rate was: PC 26.7% (16/60), AC 66.7% (4/6),
DBDC 100% (1/1), and DC 66.7% (2/3). In interval 1988 approximately 1998, for 147 patients, the
tumor resection rate was: PC 20.2% (22/109), AC 75.0% (12/16),
DBDC 50.0% (2/4), and DC 66.7% (12/18). In interval 1999 approximately 2003, for 130 patients, the
tumor resection rate was: PC 20.4% (20/98), AC 100% (4/4),
DBDC 75.0% (12/16), and DB 83.3% (10/12). Cumulatively, from 1958 to 2003, the incidence of
DBDC has become significantly higher, and the average of total
bilirubin level (TBIL) has gradually been going downward, the average of
blood transfusion during operation and the diameter of resected
tumor has been becoming smaller. From 1999 to 2003, none of the 130 periampullary
carcinoma patients had received biliary drainage before operation.
CONCLUSION: Mortality and complication have become significantly lower because of effective improvement in the perioperative preparation and the care after surgery of periampullary
cancer in the recent years. Even though the accurate diagnosis has become increasing earlier than before, the resection rate and prognosis of periampullary
carcinoma remain poor.