Tumors Of Major Duodenal Papilla Research Articles

Comparative analysis of radical surgical treatment of periampullary tumors

Retrospective analysis of patients with periampullary tumors undergoing pancreatoduodenectomy. A retrospective review included 48 patients with resectable periampullary tumors. Patients were divided into two groups according to the localization of cancer. Group 1 - pancreatic head tumors (n=27), group 2 - tumors of major duodenal papilla (n=21). Survival was analyzed depending on chemotherapy and vascular resection. All patients underwent standard pancreatoduodenectomy with anastomosis on a single intestinal loop and D2 lymph node dissection. Annual survival rate in patients with pancreatic head tumors was significantly higher compared with patients with tumors of major duodenal papilla (69.1% vs. 95.6%, p<0.05). Moreover, vascular resection (PV/SMV) was significant predictor of survival (p<0.01). There was a noticeable tendency to impaired survival if adjuvant chemotherapy was absent. Pancreatoduodenectomy is preferred for periampullary tumors since this procedure significantly increases life expectancy. Postoperative adjuvant chemotherapy is recommended in all patients regardless histological data because combined approach is associated with improved survival.

Endoscopic ultrasonography in the differential diagnosis of biliopancreatoduodenal tumors

Objective . Todeterminethe role ofendoscopicultrasonography in preoperative differentialdiagnosis of bilio pancreatoduodenal tumorsand choice of further treatment strategy. Material and methods . A retrospective analysis included medical records of 89 patients hospital-ized with suspected biliopancreatoduodenal tumor.Pancreatic head tumor was diagnosed in 41(46.1%) patients, tumorof major duodenal papilla – in 15 patients (16.9%), tumor of distal seg-ment of common bile duct – in 10 patients (11.2%), cicatricial and inflammatory strictures of distal segment of common bile duct – in 19 patients (21.3%), post-necroticpseudocysts of pancreatic head – in 4 patients (4.5%). Results . Sensitivity ofendoscopic ultrasonography for tumors of pancreatic head, major duodenal papilla, distal common bile duct, cicatricial and inflammatory strictures of distal segment of com-mon bile duct and postnecroticpseudocysts of pancreatic head was 90.2%, 100%, 80%, 94.7% and 100%, respectively. Specificity was 97.9%, 94.6%, 98.7%, 98.6% and 100%, respectively. Overall accuracy was 94.4%, 95.5%, 96.6%, 97.8% and 100%, respectively. False-negative results were obtained in 7 cases. Tumor was not excluded in these patients, but there was a conclusion about an-other primary source of growth. Conclusion . Endoscopic ultrasonography is associated with high accuracy of preoperative differen-tial diagnosis of malignant and benign biliopancreatoduodenaltumors and useful to clarify diagnosis in patients with mechanical jaundice syndrome. These data are usedas an objective criterion to de-termine further treatment strategy depending on the results of endoscopic ultrasonography.

The efficacy of endoscopic papfllectomy for tumors of major duodenal papilla

Objective To evaluate and analyse the efficacy and safety of endoscopic papillectomy for tumors of major duodenal papilla. Methods The clinical data of thirty-four patients with tumors of major duodenal papilla who were treated by endoscopic papillectomy were retrospectively reviewed, and the clinical outcome was summarized. Results The success rate of endoscopic papillectomy was 94. 12% （32/34）, and the complete resection was 66. 67% （20/30）. Short-term complications occurred in 10 cases, including postoperative gastrointestinal bleeding in 7cases and postoperative pancreatitis in 3 cases. Five cases need further surgical intervention for the reason that tumor was too deep in 2 cases, bile duct was invaded in 2 ca- ses and conservational medication was unsuccessful in 1 case. Thirty-three cases were pathologically diag- nosed as low grade intraepithelial neoplasia （LGIN）, 17 cases high grade intraepithelial neoplasia （HGIN）, 1 case carcinoid and 3 cases adenocarcinoma. The recurrence rate was 23.33 （7/33）. tumor recurrence rate of HGIN was higher than that of LGIN （42. 86% VS10%, P = 0. 078）. Conclusion Endoscopic papillecto- my is an effective method for treating tumors of major duodenal papilla, however, hemorrhage is the main postoperative complication, the recurrence rate is higher in HGIN group. Key words: Treatment outcome; Tumors of major duodenal papilla; Endoscopic papillectomy; Complications