Transduodenal Resection Research Articles

Benign tumors of the ampulla of Vater; comparison of survival following local resection of benign and malignant ampullary tumors.

THE RADICAL operation of pancreatoduodenectomy is the procedure of choice for carcinoma of the ampulla of Vater. The nature of cancer warrants this serious operation in spite of its high mortality and in spite of the fact that the operation may produce permanent nutritional disorders in the surviving patient. It is obvious that such a hazardous procedure should not be used as the surgical treatment of benign ampullary tumors. It should be possible to cure such tumors with a simple local transduodenal resection. This advice, simple in execution and logical in theory, is seldom followed in practice because the accurate histological differentiation between benign and malignant ampullary tumors is difficult, and not always possible from frozen sections taken at the time of operation. The first object of this presentation is to point out the existence of benign tumors of the ampulla of Vater and the microdiagnostic difficulties they may present.

Resection of carcinoma (carcinoid?) of the infrapapillary portion of the duodenum involving the ampulla of vater: Reimplantation of the common and pancreatic ducts

An instance of a large, slowly growing carcinoma (carcinoid?) of the second portion of the duodenum secondarily involving the ampulla of Vater is recorded. Transduodenal resection and reimplantation of common and main pancreatic ducts were performed. The patient remained free from evidence of recurrence fifteen months after operation. The special clinical feature of the case was that steatorrhea due to obstruction of the pancreatic duct was the outstanding sign and no clinical evidence of common duct obstruction was present.

Carcinoma of the pancreas and extrahepatic bile ducts

1. 1. A group of 109 cases of carcinoma of the pancreas and extrahepatic bile ducts, verified by operation or necropsy, has been reviewed. 2. 2. The disease occurred approximately twice as frequently in males as in females. 3. 3. The average age of the patients was 56.9 years. 4. 4. Weight loss was the most common symptom. It was usually extreme (average 13.8 kg.) and occurred rapidly. 5. 5. Jaundice was the most common chief complaint and abdominal pain the most common initial symptom. 6. 6. The average duration of symptoms was 5.5 months. 7. 7. Jaundice was the most common physical sign and was present in over three-fourths of the cases. 8. 8. Courvoisier's law was of relatively little value in making a correct diagnosis prior to operation. The law was of considerable value to the surgeon at the time of laparotomy, as it indicated the type of duct obstruction which was present. The operative findings proved the law to be accurate in over 80 per cent of the cases. 9. 9. Laboratory studies were of practically no value in diagnosis. 10. 10. Roentgen studies were positive or suggestive in one-fourth of the cases. 11. 11. In the non-icteric patients the difficulties in diagnosis were greater than in the icteric group. In the former cases the condition was most often confused with carcinoma of the stomach or colon. 12. 12. Evidence of antecedent biliary tract infection, as indicated by contraction of the gall-bladder or thickening of its wall, was noted in approximately one-eighth of the operative cases, while calculi were present in the gall-bladder in one-sixth. 13. 13. Cholecystogastrostomy was regarded as the best palliative operation. The operative mortality for this procedure was 29.17 per cent. 14. 14. In ten cases, according to the diagnoses made at the time of operation, the ratio of cases of carcinoma of the pancreas and of the bile ducts was 2:1. Necropsy examination of these same cases proved that the ratio was 1:2. 15. 15. In three cases of carcinoma of the ampulla of Vater, transduodenal resection was performed, with one post-operative death and two recoveries. 16. 16. Hemorrhage was the most common cause of death following operation. 17. 17. The average duration of life following palliative biliary gastrointestinal anastomosis was 7.2 months in a group of twenty-one patients traced. 18. 18. Post-mortem examination showed the most common site of metastases to be the regional lymphnodes, while metastases to the liver and lungs occurred next in frequency. 19. 19. In the group of thirty cases examined post-mortem, there were four instances of multiple malignancies.