Introduction: Pancreatic and periampullary carcinomas include a group of malignant neoplasms arising in or near the ampulla of Vater or in the pancreas. Diagnosis, management and prognosis have improved considerably in the last few decades. The present study looks into the modes of presentation in patients with periampullary carcinoma, the different modalities of investigations, treatment along with the postoperative complications.

Materials and Methods: It is a retrospective, descriptive study including 25 patients of periampullary carcinoma studied over a period of one and half year from January 2017 to June 2018 in a tertiary care centre in Visakhapatnam. In the present study, age and sex distribution, site of tumour origin, histopathological variant, postoperative complications and other factors were evaluated. We have adopted the classical Whipple’s Pancreaticoduodenectomy as the procedure for the treatment of operable periampullary cancers.

Results: The mean age of presentation was 52.6 years. The male to female ratio was 2.5:1. The most common site of tumour origin was the head of pancreas. Majority were well differentiated adenocarcinomas. The most common postoperative complications were pancreatic leak and wound infection (14.2%).

Conclusion: Patients with pancreatic and periampullary cancer represent a difficult and challenging group to treat. Pancreaticoduodenectomy is a standard procedure that has been adopted for the treatment of this group of cancers. Resection should be performed by experienced surgeons to minimize morbidity and mortality. Though these patients have a poor prognosis, with proper staging, good patient selection and appropriate management, there is improved survival and wellbeing of these patients.

1. Jagannath P, Shirkande S, Current options in the diagnosis and management of periampullary carcinoma. Indian J surg.2003;65;347-53.
2. Jakhmola CK, Kumar A. Whipple’s pancreaticoduodenectomy : Outcomes at a tertiary care hospsital. Med J Armed Forces India. 2014;70:321-6.
3. Charles J, Yeo M, John L, Cameron MD. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma comparison of morbidity and mortality and short-term outcome. Ann Surg. 1999;229(5):613-24.
4. J R Cohen, N Kuchta, N Geller, G T Shires, and P Dineen. Pancreaticoduodenectomy. A 40-year experience. Ann Surg. 1982 May; 195(5): 608-617.
5. Xun Wang, Jian Feng, Mingyi hen, ShouwangCai, JianjunLeng, Zhiwei Liu, Wenzhi Zhang. A comprehensive clinicopathological analysis and survival outcome of periampullary cancer following pancreatoduodenecomy. Int J Clin Exp Med 2016;9(8):15678-15688.
6. TaxiarchisBotsis, Valsamo KA, Gunnar Hartvigsen, Georges Hripisak and Chunhuaweng. Modeling prognostic factors in resectable pancreatic adenocarcinoma. Cancer inform 2009;7:281-91.
7. Carlos Chan, Miguel F. Herrera, Lorenzode La Garza, Leticia Quintanilla-Martinez, Florenciavargas-Vorackova et al. Clinical behaviour and prognostic factors of periampullary adenocarcinoma. Annals of Surg 1995;222(5):632-37.
8. Woo Song Ha, and JinPok Kim. A clinical study of periampullary carcinoma. Cancer Research and Treatment, 1980;12(1):79-90.
9. Tarazi RY, Hermann RE, Vogt DP, Hoerr SO, Esselstyn CB Jr, et al. Results of surgical treatment of periampullary tumours: A thirty-five year experience. Surgery.1986;100;716-21.
10. Robertson JFR, Imrie CW, Hole DJ, Carter DC, Blumgart LH. Management of periampullary carcinoma. Br J Surg. 1987;74:816-9.
11. VissaShanthi et al. Pancreatobiliary versus intestinal type of histological differentiation: A comparitive study with histomorphological prognostic factors in periampullary carcinoma. Int J Med Res Health Sci.2013;2(3):380-387.
12. Bala Ram Malla, Gabriel Rodrigues. Periampullary carcinoma: An audit of an institutional experience with literature review. Malla BR, et al. SurgChron 2017; 22(1):4-6.
13. Frederic P. Herter, Avram M. Copperman, Thomas N. Ahlborn, and Charles Antinori. Surgical Experience with pancreatic and periampullary cancer. Ann Surg. 982 Mar;195(3):274-281.
14. Amir Saraee et al. Whipple procedure: a review of a 7-year cinical experience in a referral center for hepatobiliary and pancreas diseases. World journal of oncology (2015)13:98.
15. Gupta et al. Whipple’s procedure: Yesterday and today. Int J Hepatobiliary Pancreat Dis 2015;6:1-5.

Dr Anantha Ramani Pratha

Associate Professor of Surgery, Andhra Medical College, Visakhapatnam, India