Abstract
Whipple's Pancreaticoduodenectomy has increasingly been used as an appropriate resectional procedure for tumors of the periampullary region which are pancreatic, periampullary, ampullary and biliary tumors. Our aim was to study the distribution and histopathologic features of these tumors and to examine local trends of periampullary neoplasms resected with a PD. A descriptive study was conducted in the department of Pathology, Kathmandu Medical College Teaching Hospital from July 2013 to June 2016. Thirty five patients underwent Whipple's Pancreaticoduodenectomy procedure during a period of 36 months from July 2013 to June 2016. Malignant tumor was present in 31 (88.57%) cases where as four cases (11.43%) harboured benign lesions. Periampullary mixed carcinoma was the predominant tumor (34.28%) followed by periampullary duodenal (20%), ampullary (14.28%), pancreatic adenocarcinoma (11.42%) and distal cholangiocarcinoma (5.71%). There was no significant difference in tumor size among periampullary, ampullary, pancreatic and biliary carcinomas. Ampullary carcinomas were predominantly well differentiated (80%) where as the other tumors were mostly moderately differentiated. Lymphovascular and perineural invasion varied in different tumor types. Four pancreatic adenocarcinomas showed lymphovascular and perineural invasion. Adequate surgical margin clearance was achieved in most of the cases except in one case each of periampullary duodenal carcinoma and distal cholangiocarcinoma and two cases of pancreatic adenocarcinoma.. Pancreaticoduodenectomy specimen requires thorough histopathological evaluation. Pathologists should also be aware of possibility of a benign diagnosis in PD specimens which have been resected presuming malignancy based on clinical judgement and radiological data.
Highlights
Whipple’s Pancreaticoduodenectomy has increasingly been used as an appropriate resectional procedure for tumors of the periampullary region which are pancreatic, periampullary, ampullary and biliary tumors
One case which was suspected of periampullary malignancy was found to be Periampullary adenomatous hyperplasia (2.85%) and another case suspected of distal cholangiocarcinoma did not reveal any neoplastic lesion and showed non-specific inflammation (2.85%) only
There was no significant difference in tumor size among periampullary, ampullary, pancreatic and biliary carcinomas
Summary
Whipple’s Pancreaticoduodenectomy has increasingly been used as an appropriate resectional procedure for tumors of the periampullary region which are pancreatic, periampullary, ampullary and biliary tumors. Kausch is credited with the first successful resection of the duodenum and portion of pancreas (pancreaticoduodenectomy) which was later popularized by Whipple and bears his name for the operation.[1,2] Advances in surgical technique, perioperative care and concentration of surgery in large volume centres have significantly improved mortality and morbidity associated with the Whipple’s procedure.[3,4] Today Whipple’s Pancreaticoduodenectomy has increasingly been used as a safe and appropriate resectional option for tumors of the periampullary region which are pancreatic, ampullary, biliary and duodenal tumors.[1,5]. The distribution of resected pancreatic, ampullary, biliary and duodenal carcinomas is variable in different.
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