Cirurgia de intenção curativa nos tumores peri-ampulares. Resultados de 48 ressecções consecutivas.

Periampullary tumors form a clinical entity with common symptoms, similar therapeutic options, unsatisfactory resectability rates and unfavorable prognosis. From April 1970 until March 1994, one hundred and twenty-seven patients with periampullary carcinoma were operated by our surgical team. In 48 of these patients, a resection for cure was performed (38%). Resectability rates varied according to the origin of these tumors, i.e., pancreas-20%, ampulla-76%; distal bile duct-71%, periampullary duodenum-88%. Pancreatic tumors showed a different resectability rate from the other periampullary carcinomas (p = 0.04). Forty-two of these patients had a pancreatoduodenectomy and in the remaining 6 cases a total pancreatectomy was performed. Fifteen patients had major post-operative morbidity (31%) and 8 of these cases died in-hospital (17%). Follow-up data was available in 81% of the patients, survival estimates were calculated according to the Kaplan-Meier method and survival comparisons were made with the Log-rank test. Median survival for resected pancreatic carcinoma was 6 months and for resected tumors of the ampulla 37 months. In this group of patients, pancreatic tumors showed a different survival rate from the remaining periampullary tumors (Log-rank-p = 0.002). This work evidences the need to improve management of periampullary tumors, particularly in-hospital mortality and long-term survival. To achieve these goals, patients with periampullary tumors should be treated in specialized centers and research to improve local and systemic control of this disease should be pursued.Periampullary tumors form a clinical entity with common symptoms, similar therapeutic options, unsatisfactory resectability rates and unfavorable prognosis. From April 1970 until March 1994, one hundred and twenty-seven patients with periampullary carcinoma were operated by our surgical team. In 48 of these patients, a resection for cure was performed (38%). Resectability rates varied according to the origin of these tumors, i.e., pancreas-20%, ampulla-76%; distal bile duct-71%, periampullary duodenum-88%. Pancreatic tumors showed a different resectability rate from the other periampullary carcinomas (p = 0.04). Forty-two of these patients had a pancreatoduodenectomy and in the remaining 6 cases a total pancreatectomy was performed. Fifteen patients had major post-operative morbidity (31%) and 8 of these cases died in-hospital (17%). Follow-up data was available in 81% of the patients, survival estimates were calculated according to the Kaplan-Meier method and survival comparisons were made with the Log-rank test. Median survival for resected pancreatic carcinoma was 6 months and for resected tumors of the ampulla 37 months. In this group of patients, pancreatic tumors showed a different survival rate from the remaining periampullary tumors (Log-rank-p = 0.002). This work evidences the need to improve management of periampullary tumors, particularly in-hospital mortality and long-term survival. To achieve these goals, patients with periampullary tumors should be treated in specialized centers and research to improve local and systemic control of this disease should be pursued