Is there any differences in post-operative course among the three main types of periampullary tumour?

Abstract

Background and objectives: There have been many reports of pancreaticoduodenectomy performed for the surgical treatment of periampullary cancer. However, any differences in the perioperative courses of different types of periampullary tumour are unclear. In this study, we evaluated the differences in morbidity among the three main types of periampullary tumour. Methods: Prospectively collected data from patients who underwent pancreaticoduodenectomy for periampullary tumour between 2004 to 2018 were reviewed. The patients were divided into three groups: those with pancreatic head cancer, ampulla of Vater (AOV) cancer, or distal common bile duct (CBD) cancer. Results: Among the 645 patients who underwent pancreaticoduodenectomy, 298 (46.2%) were diagnosed with pancreatic head cancer, 172 (26.7%) with AOV cancer, and 175 (27.1%) with distal CBD cancer. The group with distal CBD cancer had the highest mean age (68.45 ± 9.2 years; p = 0.002) and the highest total bilirubin level (8.72 ± 0.6) mg/dl among the three groups. The group with pancreatic head cancer had the highest rate of firm pancreatic texture (71.7%) and the greatest duct diameter (4.64 ± 0.2 mm) among the three groups. Pancreatic fistula and pulmonary complications were more frequent in the groups with AOV cancer and distal CBD cancer. Post-operative haemorrhage occurred at a higher rate in the group with distal CBD cancer (12%). The hospital stay was longer in the group with distal CBD cancer (27.30 ± 1.3 days). Conclusion: Among the three main types of periampullary tumour, the group with distal CBD cancer had the highest complication rate and the longest hospital stay.