Periampullary Carcinoma Research Articles

Diagnostic Accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) In-Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for Pancreaticobiliary Disorders

This is a prospective study done to compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for pancreaticobiliary disorders.Majority of the study participants were males (63.3%), while the rest 36.78% of them were females and periampullary carcinoma (11.7%) and common bile duct calculus (11.7%) are the common cause of obstruction found on MRCP followed by malignant stricture (10%). The extent of obstruction was determined in most of the study participants (91.7%) by MRCP while the rest 8.3% were not determined by MRCP. The Common bile duct calculus (11.7%) is the common cause of obstruction on ERCP followed by malignant stricture (10%) and Periampullary carcinoma (10%) and 20% of the patients were found to be normal in ERCP. Among them, 71.4 % did not show MRCP and the association was found to be significant. (p- Value < 0.00).

1486P Clinicopathological characteristics and prognostic factors of ampullary cancer: A tertiary care centre experience over 10 years

Ampullary cancers represent a subset of periampullary carcinoma, accounting for only 0.2% gastrointestinal cancers. Localised disease is treated with pancreaticoduodenectomy followed by chemo-radiation or chemotherapy. In this study, various clinico-pathologic factors were assessed for recurrence and survival.

A CT-Based Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Periampullary Carcinomas.

PurposeTo establish and validate a radiomics nomogram for preoperatively predicting lymph node (LN) metastasis in periampullary carcinomas.Materials and MethodsA total of 122 patients with periampullary carcinoma were assigned into a training set (n = 85) and a validation set (n = 37). The preoperative CT radiomics of all patients were retrospectively assessed and the radiomic features were extracted from portal venous-phase images. The one-way analysis of variance test and the least absolute shrinkage and selection operator regression were used for feature selection. A radiomics signature was constructed with logistic regression algorithm, and the radiomics score was calculated. Multivariate logistic regression model integrating independent risk factors was adopted to develop a radiomics nomogram. The performance of the radiomics nomogram was assessed by its calibration, discrimination, and clinical utility with independent validation.ResultsThe radiomics signature, constructed by seven selected features, was closely related to LN metastasis in the training set (p < 0.001) and validation set (p = 0.017). The radiomics nomogram that incorporated radiomics signature and CT-reported LN status demonstrated favorable calibration and discrimination in the training set [area under the curve (AUC), 0.853] and validation set (AUC, 0.853). The decision curve indicated the clinical utility of our nomogram.ConclusionOur CT-based radiomics nomogram, incorporating radiomics signature and CT-reported LN status, could be an individualized and non-invasive tool for preoperative prediction of LN metastasis in periampullary carcinomas, which might assist clinical decision making.

The Landscape of Genetic Alterations Stratified Prognosis in Oriental Pancreatic Cancer Patients.

BackgroundPancreatic cancer is a life-threatening malignant disease with significant diversity among geographic regions and races leading to distinct carcinogenesis and prognosis. Previous studies mainly focused on Western patients, while the genomic landscape of Oriental patients, especially Chinese, remained less investigated.MethodsA total of 408 pancreatic cancer patients were enrolled. A panel containing 436 cancer-related genes was used to detect genetic alterations in tumor samples.ResultsWe profiled the genomic alteration landscape of pancreatic duct adenocarcinoma (PDAC), intraductal papillary mucinous neoplasm (IPMN), periampullary carcinoma (PVC), and solid-pseudopapillary tumor (SPT). Comparison with a public database revealed specific gene mutations in Oriental PDAC patients including higher mutation rates of DNA damage repair-related genes. Analysis of mutational signatures showed potential heterogenous carcinogenic factors caused by diabetes mellitus. KRAS mutation, especially KRAS G12D mutation, was associated with poor survival, while patients not harboring the 17 significant copy number variations (CNVs) had a better prognosis. We further identified multiple correlations between clinicopathologic variables and genetic mutations, as well as CNVs. Finally, by network-based stratification, three classes of PDAC patients were robustly clustered. Among these, class 1 (characterized by the Fanconi anemia pathway) achieved the best outcome, while class 2 (involved in the platinum drug resistance pathway) suffered from the worst prognosis.ConclusionsIn this study, we reported for the first time the genetic alteration landscape of Oriental PDAC patients identifying many Oriental-specific alterations. The relationship between genetic alterations and clinicopathological factors as well as prognosis demonstrated important genomic impact on tumor biology. This study will help to optimize clinical treatment of Oriental PDAC patients and improve their survival.

Multimodal treatment of periampullary carcinoma

Ampullary carcinoma is arare malignant neoplasm and arises in the region of Vater's ampulla. The differentiation from pancreatic and distal cholangiocarcinoma can be difficult. The prognosis is more favorable than for pancreatic ductal adenocarcinoma but recurrences are frequent. An exact diagnostic clarification and differentiation from pancreatic carcinoma is therefore essential. Although the resection of periampullary carcinoma is established, prospectively controlled studies on the role of multimodal treatment are rare. Adjuvant chemotherapy is oriented to the protocols for pancreatic carcinoma and could be of benefit in lymph node metastases, advanced T stage and low differentiation of tumors. Intestinal and pancreatobiliary subtypes can be differentiated histologically, which is relevant for systemic treatment strategies. Patients with pancreatobiliary differentiated tumors in particular could benefit from gemcitabine-based treatment but insufficient evidence exists for chemoradiotherapy. The role of neoadjuvant and perioperative treatment strategies is currently unclear. Molecular characterization can help to identify familial risk constellations and targeted treatment strategies for this rare tumor entity.

P-238 Clinicopathological profile and prognostic factors impacting survival of periampullary carcinoma: A tertiary care centre experience

Periampullary carcinoma is treated with pancreaticoduodenectomy followed by adjuvant therapy. However, it is difficult to decide the treatment regimen as periampullary carcinomas exhibit different clinical behaviours depending on the site of origin. There are various prognostic factors which impact the adjuvant treatment as well as the survival. This study aims to explore the clinicopathological profile of patients and prognostic factors affecting survival in periampullary carcinoma.

Abstract 1985: Activation of EGFR/IGF1R - beta catenin - CD44 pathway in periampullary cancer

Abstract Background: Periampullary cancer (PC) is a global medical burden, although infrequent but less than 5% of patients experience an overall survival of five years or more. The study aims to analyze the importance of Epidermal Growth Factor Receptor (EGFR)/Insulin-Like Growth Factor 1 Receptor (IGF1R) - Beta-catenin (β-catenin)- CD44 pathway in the development of periampullary cancer of Indian patients. Materials and Methods: Expression profile of EGFR, IGF1R, β-catenin, and CD44 was verified by immunohistochemical analysis in primary tumor samples (N=14) and respective adjacent normal tissues. Results: In periampullary carcinoma patients, a high level of EGFR expression was seen in 64% of the samples along with co-expression of IGF1-R in 77.8% samples. Furthermore, the high expression of EGFR and IGF1R significantly correlated with the increased expression of β-catenin along with CD44 expression of the tumors. Conclusion: The EGFR/IGF1R - β-catenin- CD44 pathway seems to be important in the development of PC with clinical importance. Key-words: Periampullary cancer; EGFR; IGF1R; β-catenin; CD44 Key Messages: Interplay of EGFR, IGF1R, β-Catenin and CD44 expressions is important phenomena in the development of PC. Citation Format: Suvendu Maji, Biswabandhu Bankura, Chinmay Kumar Panda, Neyaz Alam. Activation of EGFR/IGF1R - beta catenin - CD44 pathway in periampullary cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1985.

Outcomes of early reoperation in severe pancreatic fistula and/or haemorrhage after pancreaticoduodenectomy

Although advances in multidisciplinary management reduce the mortality after pancreaticoduodenectomy (PD) from medical complications, postoperative pancreatic fistula (POPF) and/or postpancreatectomy haemorrhage (PPH) still remain as common morbidities and main causes of mortality. The morbidity of POPF and/or PPH after PD in our centre, Yangon Specialty Hospital, is 18-30% per year. And there are still ongoing disputes regarding management of POPF and/or PPH after PD. It is a hospital based prospective descriptive study carried out between 2018 January and 2020 April in surgical units at Yangon General Hospital, New Yangon General Hospital and our centre. Total 28 reoperated patients with POPF and/or PPH patients after PD were included in the study. The indications for reoperation in this study were patients with SIRS together with drain amount more than 300 ml/day and/or blood in drain/ NGT with Hb drop ≥ 3 g% or sentinel bleed. Preoperative CECT scan was done if condition was favorable. In this study, demographic distribution, proportion of reoperation, timing of reoperation, types of procedure were also recorded while outcomes of reoperation was emphasized in this eposter. There were 56 patients who suffered from POPF and/or PPH after PD for periampullary carcinoma during this study period. Although reoperation was advised to 34 patients, who met the indications for reoperation, six of them declined operation for various reasons. Therefore, total 28 patients were reoperated (50%). Fig. 1 showed the intraoperative findings of POPF and PPH patient. Median timing of reoperation was 9 days (2-25 days) and 71% were reoperated within 10 days. While external tube wirsungosotmy (Fig. 2) was performed in majority of POPF cases as a damage control surgery, PPH patients ended up with mainly laparotomy and GDA ligation for arrest of haemorrhage because of lack of interventional radiology (IR) support at present. Among reoperated patients, 14 patients (50%) survived and 14 patients (50%) expired. Therefore, overall in-hospital mortality was 50% in reoperated cases. The main cause was multi-organ failure due to severe sepsis. According to the Fig. 3, in-hospital mortality rate of POPF was 16% and that of PPH was 66% while that of POPF and PPH was 80% in this study. Gangl et al. (2011) [1] reported that the combination of pancreatic fistula and severe hemorrhage was a strong predictor of postoperative mortality (relative risk (RR), 22.75). And Tamijmarane et al. (2006) [2] pointed out that patients themselves are in such a moribund condition that their associated mortality rate ranges between 38 and 50%. In addition, it was surprisingly found that all six patients, who needed reoperation, died with conservative management in this study. It is found that reoperation is necessary in patients when it is indicated i.e. mainly clinical based. Early reoperation and damage control surgery is found to have better outcomes in especially POPF patients before organ failure or haemorrhage supervenes. And it is hard to say the accurate timing of reoperation and optimal procedures because this study has some limitations like small sample size, and limited resources for multidisciplinary management. Therefore, further study with larger sample size and optimal resources and management will be necessary for better and more significant results. Showing intraoperative findings of POPF and PPH. Showing method of external tube Wirsungostomy insertion. Outcomes of reoperative management.

PERIAMPULLARY ADENOCARCINOMA: A RARE REPORT FROM SOUTH INDIA

Periampullary malignancy is the term utilized for neoplasms emerging from the head of pancreas, ampulla of Vater, distal bile pipe and periampullary distinct of duodenum. Of these, the pancreatic adenocarcinoma conveys the most noticeably awful anticipation with greater part of mortalities.Studies have shown that pancreatic carcinoma has the most limited middle endurance of 17.1 months of all periampullary carcinomas. Herein, we present a case of a 63-year-old male patient without any history of trauma or important previous symptoms presented to the tertiary care hospital with compliance of sudden weight loss and abdominal pain over the preceding 3 months. On examination he was deeply jaundice. His laboratory and radiological examination revealed periampullary adenocarcinoma. This individual had successfully underwent Whipple procedure and followed by Chemotherapy. This case is being presented not only the cancer is rare but also to understand and improve better clinical insight on this rare disease

The Expression of Immune Checkpoint Inhibitors PDL-1 and CTLA-4 in Pancreatic Versus Non-Pancreatic Periampullary Adenocarcinoma: An Immunohistochemical Study

Background: Periampullary cancers constitute about 5% of gastrointestinal malignancies. They are comprised of tumors of diverse origins and are generally subdivided into pancreatic and non-pancreatic carcinomas. Immune checkpoint regulators, cytotoxic T-lymphocyte antigen 4 (CTLA-4), and the programmed cell death ligand-1 (PDL-1) have emerged as promising new targets for cancer therapeutics. Aim: This study aims to determine the possible role of immune checkpoint inhibitors PDL-1 and CTLA-4 in periampullary carcinoma of pancreatic and non-pancreatic adenocarcinoma subtypes, in an attempt to investigate the possible introduction of their related immunotherapy in the management of these tumors. Materials and Methods: Expression of immune inhibitory molecules was examined by immunohistochemistry in 40 cases including (20) pancreatic adenocarcinoma and (20) non-pancreatic adenocarcinoma. The association between markers and clinicopathological parameters was evaluated. Results: Statistically significant differences in the immunoexpression of both CTLA-4 and PDL-1 in the two studied groups were noticed with higher expression in non-pancreatic adenocarcinoma in relation to pancreatic adenocarcinoma (P=0.004, P=0.008) respectively. PDL-1 expression was positive in 15% and 55% of pancreatic and non-pancreatic adenocarcinoma cases, respectively with a significant correlation with lymph nodes metastasis in non-pancreatic adenocarcinoma cases. CTLA-4 was positive in 20% of pancreatic carcinoma with a significant correlation with lymph node metastasis, perineural invasion and T stage. In non-pancreatic periampullary adenocarcinoma, CTLA-4 was positive in 65% of cases with a significant association with lymph nodes metastasis and T stage. Conclusions: Immunotherapy using anti-PDL-1 and CTLA-4 are proposed as a novel promising management tool in non-pancreatic periampullary adenocarcinoma not in pancreatic adenocarcinomas.

Identifying Periampullary Regions in MRI Images Using Deep Learning.

BackgroundDevelopment and validation of a deep learning method to automatically segment the peri-ampullary (PA) region in magnetic resonance imaging (MRI) images.MethodsA group of patients with or without periampullary carcinoma (PAC) was included. The PA regions were manually annotated in MRI images by experts. Patients were randomly divided into one training set, one validation set, and one test set. Deep learning methods were developed to automatically segment the PA region in MRI images. The segmentation performance of the methods was compared in the validation set. The model with the highest intersection over union (IoU) was evaluated in the test set.ResultsThe deep learning algorithm achieved optimal accuracies in the segmentation of the PA regions in both T1 and T2 MRI images. The value of the IoU was 0.68, 0.68, and 0.64 for T1, T2, and combination of T1 and T2 images, respectively.ConclusionsDeep learning algorithm is promising with accuracies of concordance with manual human assessment in segmentation of the PA region in MRI images. This automated non-invasive method helps clinicians to identify and locate the PA region using preoperative MRI scanning.

Recognition and pathological features of periampullary region adenocarcinoma with an indeterminable origin.

Determination of the primary tumor in periampullary region carcinomas can be difficult, and the pathological assessment and clinicopathological characteristics remain elusive. In this study, we investigated the current recognition and practices for periampullary region adenocarcinoma with an indeterminable origin among expert pathologists through a cognitive survey. Simultaneously, we analyzed a prospective collection of cases with an indeterminable primary tumor diagnosed from 2008 to 2018 to elucidate their clinicopathological features. All cases with pathological indeterminable primary tumors were reported and discussed in a clinicopathological conference to elucidate if it was possible to distinguish the primary tumor clinically and pathologically. From the cognitive survey, over 85% of the pathologists had experienced cases with indeterminable primary tumors; however, 70% of the cases was reported as pancreatic cancer without definitive grounds. Interpretation of the main tumor mass varied, and no standardized method was developed to determine the primary tumor. During a prospective study, 42 of the 392 periampullary carcinoma cases (10.7%) were considered as tumors with a pathological indeterminable origin. After the clinicopathological conferences, 21 (5.4%) remained indeterminable and were considered final indeterminable cases. Histological studies showed that the tumors spread along both the bile duct and main pancreatic duct; this was the most representative finding of the final indeterminable cases. This study is the first to elucidate and recognize the current clinicopathological features of periampullary region adenocarcinomas with an indeterminable origin. Adequate assessment of primary tumors in periampullary region carcinomas will help to optimize epidemiological data of pancreatic and bile duct cancer.

Clinical spectrum of obstructive jaundice: a descriptive crosssectional study

Objective. The objective of this study was to evaluate the clinical spectrum of obstructive jaundice in inflammation, stone disease, and malignancy. Methods. A descriptive observational study was done among 50 patients with the diagnosis of obstructive jaundice during the period 2012 to 2013. A detailed history and clinical examinations and radiological confirmation were done. Results. Among the participants, 74% participants had jaundice, 58% with vomiting as presenting complaints. Among benign cases, 60% were choledocholithiasis, 25% were common bile duct stricture, and 15% were choledochal cyst. Among malignant cases, 26.67% were periampullary carcinoma, 23.33% had carcinoma of the pancreas head, and 13.33% had D2 duodenal carcinoma. Conclusions. The etiology of obstructive jaundice was malignancy in the elderly male population. The most common presenting features were yellowish discoloration of skin and mucosa followed by vomiting and abdominal pain.

Management of locally advanced periampullary tumors: A multicenter study

Background: Pancreas may develop either benign or malignant tumors. Pancreatic cancer (PC) is one of the most lethal solid tumors which ranking as the fourth cause of cancer-related death in the United States. Aim: To analyze the results of treatment of locally advanced pancreatic cancer to come up with management strategy. Patients and Methods: Patients (n=136) were retrospectively evaluated with periampullary carcinoma where 40 patients were diagnosed as locally advanced periampullary carcinoma, from January 2010 to January 2018 in multicenter. Results: Patients diagnosed as pancreatic head carcinoma in 20/40 and periampullary carcinoma in 20/40 of patients, all patients were diagnosed as locally advanced pancreatic cancer by radiological imaging, where 28/40 (70%) was males and 12/40 (30%) were females with male:female ratio of 2.3:1. The age of patients at diagnosis was 39-62 years with a median age of 51 years. All patientswere = evaluated and followed up for 24 months with Multislice CT, PET-CT and tumor markers. Some patients underwent neoadjuvant treatment for down staging and were then surgery was done for 25/40 cases. Whipple’s operation without VR in 17/25 and VR done in 8/25 cases, where 6/40 cases died during chemotherapy and 9/40 unfit for surgery due to disseminated disease and complications of chemotherapy. Conclusion: Pancreatic cancer patients diagnosed as locally advanced or metastatic tumor need MDT to decide different modes of treatment in order to obtain better results

Clinical characteristics and outcome of tumor-associated acute pancreatitis: a single-center cohort study

BackgroundWhat features should alert clinicians to suspect underlying tumors in patients with acute pancreatitis (AP) was largely unknown. This study aimed to assess the clinical characteristics and outcome in patients with tumor-associated AP.MethodsPatients who presented with AP and were diagnosed with tumor after admission were included according to the inclusion and exclusion criteria and followed up by hospital notes, telephone, WeChat and/or e-mail. The clinical characteristics and outcome were analyzed with multivariable logistic regression and were compared with AP patients without tumor.ResultsOut of a cohort of 1,792 AP patients we identified 103 who had a neoplastic etiology. The 103 patients had a median age of 57 (range, 13–81) and 65 were males. AP was mild in 92 patients, moderately severe in 7 and severe in 4. The three most common tumors included pancreatic cancer (PC) (40), periampullary carcinoma (PAC) (25), and neoplastic pancreatic cysts (NPC) (22). The following ranked features were predictive of a tumor etiology: dilation of main pancreatic duct (MPD) (OR 417.83, 95% CI: 80.40–2,171.42), vascular invasion (OR 82.04, 95% CI: 6.05–1,113.14), mild AP (8.29, 95% CI: 1.98–34.73), and anemia (OR 5.73, 95% CI: 2.02–16.26). The median survival period of AP patients with PC, PAC, and NPC was 10.0 (7.0–23.5), 21.0 (5.0–37.0), and 35.0 (30.0–96.0) months, respectively.ConclusionsMild AP patients with dilation of MPD, vascular invasion, and anemia were more frequently suggested a tumor etiology. Thus, clinical vigilance is needed for timely detection of tumor-associated pancreatitis with these characteristics.

Role of Magnetic Resonance Cholangiopancreatography in the Evaluation of Obstructive Jaundice

Background Magnetic Resonance Cholangiopancreatography is a reliable and highly sensitive imaging modality in the diagnosis of Obstructive jaundice.&#x0D; Objective To evaluate the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography as compared to Endoscopic Retrograde Cholangiopancreatography.&#x0D; Method A prospective, analytical study was conducted in the Department of Radiodiagnosis and Imaging at Dhulikhel Hospital between October 2018 and December 2020. Altogether 100 patients of all ages with obstructive jaundice undergoing Magnetic Resonance Cholangiopancreatography and Endoscopic Retrograde Cholangiopancreatography were included. The causes of obstructive jaundice as identified by Magnetic Resonance Cholangiopancreatography were compared to that of Endoscopic Retrograde Cholangiopancreatography considering Endoscopic Retrograde Cholangiopancreatography as gold standard for the diagnosis.&#x0D; Result Magnetic Resonance Cholangiopancreatography revealed choledocholithiasis in 60 (60%) patients, benign stricture – 14(14%), malignant stricture-11(11%), periampullary carcinoma in 8(8%) and normal study in 4(4%) patients. Endoscopic Retrograde Cholangiopancreatography showed choledocholithiasis in 59(59%) patients, strictures (benign in 13%, malignant in 10%), ascariasis in 3(3%) and normal findings in 5(5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of Magnetic Resonance Cholangiopancreatography in detecting choledocholithiasis were 96.6%, 92.3%, 95%, and 95%. The same values for benign strictures were 92.3%, 97.7%, 85.7% and 98.9%, whereas those for malignant strictures were 90.9%, 98.8%, 90.9% and 98.8%. All values were 100% for peri-ampullary carcinoma and ascariasis. Hence, Magnetic Resonance Cholangiopancreatography showed good accuracy for detecting causes of obstructive jaundice (p &lt; 0.05) as compared to Endoscopic Retrograde Cholangiopancreatography.&#x0D; Conclusion Magnetic Resonance Cholangiopancreatography is an accurate, non-invasive technique in evaluation of obstructive jaundice and offers similar diagnostic value compared to Endoscopic Retrograde Cholangiopancreatography.

English

BACKGROUND Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging method of demonstration of hepatic, cholangio- and pancreatic-systems and their duct system and depends on heavy T2-weighted (T2-W) images. The present study was undertaken to study and evaluate patients with clinical suspicion of the biliary tract, gall bladder and pancreatic pathology, with conventional magnetic resonance imaging (MRI) and MRCP and to assess the pitfalls in MRCP for the evaluation of the biliary tract, gall bladder, and pancreas. METHODS The study included sixty patients with clinical signs and symptoms of obstructive jaundice referred for MRCP to the Department of Radiodiagnosis at Katuri Medical College and Hospital and patients who were referred to the department with clinical suspicion of pancreas, gallbladder and biliary tract disease. Pregnant patients, claustrophobic patients and patients with MRI contraindications such as cardiac pacemakers, aneurysm clips and metallic implants were excluded from the study. RESULTS Most of the patients in our study were of 30 - 70 years age group. Of the sixty cases included in our study, 58 % were males and 42 % were females. In most of the patients, in our study, benign pathology was observed which included cholelithiasis and choledocholithiasis and acute pancreatitis being next common. Case of choledochal cyst were also encountered. Most of common bile duct strictures were of benign aetiology. Of the malignant pathology detected, cholangiocarcinoma followed by periampullary carcinoma and gallbladder carcinoma were commonly encountered. CONCLUSIONS Magnetic resonance pancreatic cholangiography is an imaging modality for evaluation of pancreaticobiliary disorders. MRCP detected the exact location and cause of biliary tract obstruction and aetiology was well demonstrated. Pure cholesterol stones are difficult to detect on CT because they are iso attenuating or slightly hypoattenuating to bile. Sub centimetric calculi are well demonstrated by MRCP. Malignant strictures and benign strictures are well demonstrated. MRCP being non-invasive and radiation hazard free with inherent high resolution with multiplanar imaging capability could be considered as gold standard in imaging of few gall bladder and biliary system disorders. KEYWORDS Magnetic Resonance Cholangiopancreatography, Cholelithiasis, Pancreatitis, Periampullary Carcinoma, Gall Bladder Carcinoma, Cholangiocarcinoma

Does Pyloric-ring Resection in Pancreaticoduodenectomy Prevent Delayed Gastric Emptying?

Objective: Delayed gastric emptying (DGE) is a common, post pancreaticoduodenectomy (PD) complication, which prolongs hospital stay, increases the cost of treatment and delays adjuvant therapy. Although, pylorospasm is one of the proposed mechanisms, the results of pyloric ring resection PD remain controversial. Hence, this study investigated whether pyloric ring resection PD decreased the incidence of DGE.Material and Methods: Between June, 2015 and July, 2018; 74 patients underwent a PD for periampullary lesions, of whom 25 patients received pylorus-preserving PD (PPPD) and 49 patients received pyloric-ring resection PD (PRPD). DGE was classified according to the International Study Group of Pancreatic Surgery.Results: The incidence of DGE in the PPPD group and PRPD group were 48.0% (12 of 25 patients) and 20.4% (10 of 49 patients), respectively (p-value=0.029). Factors associated with DGE were pyloric preserving [adjusted Odds ratio (OR)=8.26, 95% confidence interval (CI): 1.96-34.82, p-value=0.002], preoperative biliary drainage (adjusted OR=0.19, 95% Cl: 0.05-0.78, p-value=0.013) and postoperative intraabdominal collection (adjusted OR=37, 95% Cl: 5.68-241.24, p-value&lt;0.001).Conclusion: PRPD demonstrated a significant decrease of DGE, and should be one of the standard surgical treatments for periampullary carcinoma.

English

BACKGROUND Extra-hepatic biliary tract obstruction can be due to a number of conditions. Most causes are due to stones in the common biliary duct or due to malignant obstruction. Malignant causes include carcinoma head of pancreas, periampullary carcinoma and cholangiocarcinoma. Besides calculus and malignant obstruction, benign and malignant strictures can also cause obstruction of extra hepatic biliary ducts. The objectives of the study were to describe the clinical profile of patients presenting with extra-hepatic biliary obstruction and to assess the known aetiological factors. METHODS The research was designed as a hospital based cross-sectional study in the general surgery wards of our institution from 2016 to 2017. All individuals who were diagnosed to have extra-hepatic biliary obstruction by imaging were included in the study. RESULTS Among the 66 cases studied, majority were due to malignancies and gall stones. The malignancies included carcinoma head of pancreas, periampullary carcinoma, cholangiocarcinoma and Klatskin’s tumour. Miscellaneous causes were bile duct stricture, cholelithiasis with biliary sludge and annular pancreas. For the malignant cases, Whipple surgery and its pylorus-preserving variant were the most common surgical procedures carried out. Biliary bypass procedures were also carried out in some patients. For patients with common bile duct (CBD) stones, cholecystectomy, choledocholithotomy and choledochojejunostomy were done. CONCLUSIONS Malignant causes of jaundice are more common than benign causes. Secondary stones are the commonest cause of non-malignant biliary obstruction. Jaundice is more severe and associated with pruritis and more intolerable and persistent in malignancy. Surgical bypass procedures give good palliation for obstructive jaundice. KEY WORDS Bile Ducts, Choledocholithiasis, Cholestasis, Extra Hepatic, Pancreatic Cancer, Periampullary Cancer

The Role of CT in Assessment of Extraregional Lymph Node Involvement in Pancreatic and Periampullary Cancer: A Diagnostic Accuracy Study.

To investigate the diagnostic accuracy of CT in assessing extraregional lymph node metastases in pancreatic head and periampullary cancer. This prospective observational cohort study was performed at two tertiary hepatopancreatobiliary (HPB) referral centers between March 2013 and December 2014. Patients undergoing pancreatoduodenectomy or bypass surgery with or without palliative radiofrequency ablation were included. Extraregional lymph node involvement was defined as positive lymph nodes in the aortocaval window. Two expert HPB radiologists assessed aortocaval lymph nodes at preoperative CT according to a standardized protocol. All tissue from the aortocaval window was collected intraoperatively. Positive histopathologic finding was the reference standard. Analysis of predictive values and diagnostic accuracy was performed. A total of 198 consecutive patients (mean age, 66 years; range, 39-86 years; 105 men) with pancreatic head or periampullary carcinoma were included. In 70% of patients, a pancreatoduodenectomy was performed, 4% underwent total pancreatectomy, 4% underwent radiofrequency ablation, and 22% underwent bypass surgery. Forty-four patients (22%) had histologically positive aortocaval lymph nodes. Negative predictive value of CT in assessing aortocaval lymph nodes was 80% for both observers, and positive predictive value was 31%-33%. Overall diagnostic accuracy was 69%-70%. CT has a low diagnostic accuracy in assessing extraregional lymph node metastases in patients suspected of having pancreatic or periampullary cancer.Keywords: CT, Abdomen/GI, Pancreas, Oncology© RSNA, 2021.