Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s

Taylor A. Sohn, Keith D. Lillemoe, John L. Cameron, John J. Huang, Henry A. Pitt, Charles J. Yeo

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

Background: Advances in the nonoperative staging and palliation of periampullary carcinoma have dramatically changed the management of this disease. Currently, surgical palliation is used primarily for patients found to be unresectable at the time of laparotomy performed for the purpose of determining resectability. Study Design: A review of all patients undergoing operative management for periampullary adenocarcinoma at a single, high- volume institution was performed. The review focused on patients found to be unresectable who, therefore, underwent surgical palliation. Results: Between December 1991 and December 1997, 256 patients with unresectable periampullary adenocarcinoma were operatively palliated. During the same time period, 512 patients underwent pancreaticoduodenectomy (PD) for periampullary carcinoma. Sixty-eight percent of patients were unresectable secondary to liver metastases or peritoneal metastases, and 32% were deemed unresectable because of local vascular invasion. Of the 256 patients, 51% underwent double bypass (hepaticojejunostomy [HJ] and gastrojejunostomy [GJ]), 11% underwent HJ alone, 19% underwent GJ alone, and 19% did not undergo any form of bypass. Celiac block was performed in 75% of patients. Palliated patients were significantly younger, with a mean age of 64.0 years compared with 65.8 years in the resected group (p = 0.04). Gender and race distributions were similar in the 2 groups, with 57% of palliated patients and 55% of resected patients being men (p = NS) and 91% of patients in each group being Caucasian (p = NS). Palliative procedures were performed with a mortality rate of 3.1%, compared to 1.9% in those successfully resected (p = NS). Those undergoing operative palliation had a significantly lower incidence of postoperative complications when compared with those undergoing pancreaticoduodenectomy (22% versus 35%, p<0.0001) and had significantly shorter lengths of stay (10.3 days versus 14.8 days, p < 0.0001). As expected, palliated patients had a significantly poorer prognosis, with 1-, 2- and 4-year survivals of 25%, 9%, and 6% (median 6.5 months), respectively, compared with 75%, 47%, and 24% in their resectable counterparts (median 21 months, p < 0.0001). Conclusions: Surgical palliation continues to play an important role in the management of periampullary carcinoma. In this high-volume center, 33% of patients undergoing operative management of this disease were unresectable. Surgical palliation can be accomplished with acceptable perioperative mortality (3.1%) and morbidity (22%), with excellent longterm results.

Original languageEnglish
Pages (from-to)658-669
Number of pages12
JournalJournal of the American College of Surgeons
Volume188
Issue number6
DOIs
StatePublished - Jun 1999
Externally publishedYes

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Adenocarcinoma
Pancreaticoduodenectomy
Gastric Bypass
Disease Management
Carcinoma
Neoplasm Metastasis
Mortality
Abdomen
Laparotomy
Blood Vessels
Length of Stay
Morbidity
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Sohn, T. A., Lillemoe, K. D., Cameron, J. L., Huang, J. J., Pitt, H. A., & Yeo, C. J. (1999). Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. Journal of the American College of Surgeons, 188(6), 658-669. https://doi.org/10.1016/S1072-7515(99)00049-6

Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. / Sohn, Taylor A.; Lillemoe, Keith D.; Cameron, John L.; Huang, John J.; Pitt, Henry A.; Yeo, Charles J.

In: Journal of the American College of Surgeons, Vol. 188, No. 6, 06.1999, p. 658-669.

Research output: Contribution to journalArticle

Sohn, Taylor A. ; Lillemoe, Keith D. ; Cameron, John L. ; Huang, John J. ; Pitt, Henry A. ; Yeo, Charles J. / Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. In: Journal of the American College of Surgeons. 1999 ; Vol. 188, No. 6. pp. 658-669.
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title = "Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s",
abstract = "Background: Advances in the nonoperative staging and palliation of periampullary carcinoma have dramatically changed the management of this disease. Currently, surgical palliation is used primarily for patients found to be unresectable at the time of laparotomy performed for the purpose of determining resectability. Study Design: A review of all patients undergoing operative management for periampullary adenocarcinoma at a single, high- volume institution was performed. The review focused on patients found to be unresectable who, therefore, underwent surgical palliation. Results: Between December 1991 and December 1997, 256 patients with unresectable periampullary adenocarcinoma were operatively palliated. During the same time period, 512 patients underwent pancreaticoduodenectomy (PD) for periampullary carcinoma. Sixty-eight percent of patients were unresectable secondary to liver metastases or peritoneal metastases, and 32{\%} were deemed unresectable because of local vascular invasion. Of the 256 patients, 51{\%} underwent double bypass (hepaticojejunostomy [HJ] and gastrojejunostomy [GJ]), 11{\%} underwent HJ alone, 19{\%} underwent GJ alone, and 19{\%} did not undergo any form of bypass. Celiac block was performed in 75{\%} of patients. Palliated patients were significantly younger, with a mean age of 64.0 years compared with 65.8 years in the resected group (p = 0.04). Gender and race distributions were similar in the 2 groups, with 57{\%} of palliated patients and 55{\%} of resected patients being men (p = NS) and 91{\%} of patients in each group being Caucasian (p = NS). Palliative procedures were performed with a mortality rate of 3.1{\%}, compared to 1.9{\%} in those successfully resected (p = NS). Those undergoing operative palliation had a significantly lower incidence of postoperative complications when compared with those undergoing pancreaticoduodenectomy (22{\%} versus 35{\%}, p<0.0001) and had significantly shorter lengths of stay (10.3 days versus 14.8 days, p < 0.0001). As expected, palliated patients had a significantly poorer prognosis, with 1-, 2- and 4-year survivals of 25{\%}, 9{\%}, and 6{\%} (median 6.5 months), respectively, compared with 75{\%}, 47{\%}, and 24{\%} in their resectable counterparts (median 21 months, p < 0.0001). Conclusions: Surgical palliation continues to play an important role in the management of periampullary carcinoma. In this high-volume center, 33{\%} of patients undergoing operative management of this disease were unresectable. Surgical palliation can be accomplished with acceptable perioperative mortality (3.1{\%}) and morbidity (22{\%}), with excellent longterm results.",
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T1 - Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s

AU - Sohn, Taylor A.

AU - Lillemoe, Keith D.

AU - Cameron, John L.

AU - Huang, John J.

AU - Pitt, Henry A.

AU - Yeo, Charles J.

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N2 - Background: Advances in the nonoperative staging and palliation of periampullary carcinoma have dramatically changed the management of this disease. Currently, surgical palliation is used primarily for patients found to be unresectable at the time of laparotomy performed for the purpose of determining resectability. Study Design: A review of all patients undergoing operative management for periampullary adenocarcinoma at a single, high- volume institution was performed. The review focused on patients found to be unresectable who, therefore, underwent surgical palliation. Results: Between December 1991 and December 1997, 256 patients with unresectable periampullary adenocarcinoma were operatively palliated. During the same time period, 512 patients underwent pancreaticoduodenectomy (PD) for periampullary carcinoma. Sixty-eight percent of patients were unresectable secondary to liver metastases or peritoneal metastases, and 32% were deemed unresectable because of local vascular invasion. Of the 256 patients, 51% underwent double bypass (hepaticojejunostomy [HJ] and gastrojejunostomy [GJ]), 11% underwent HJ alone, 19% underwent GJ alone, and 19% did not undergo any form of bypass. Celiac block was performed in 75% of patients. Palliated patients were significantly younger, with a mean age of 64.0 years compared with 65.8 years in the resected group (p = 0.04). Gender and race distributions were similar in the 2 groups, with 57% of palliated patients and 55% of resected patients being men (p = NS) and 91% of patients in each group being Caucasian (p = NS). Palliative procedures were performed with a mortality rate of 3.1%, compared to 1.9% in those successfully resected (p = NS). Those undergoing operative palliation had a significantly lower incidence of postoperative complications when compared with those undergoing pancreaticoduodenectomy (22% versus 35%, p<0.0001) and had significantly shorter lengths of stay (10.3 days versus 14.8 days, p < 0.0001). As expected, palliated patients had a significantly poorer prognosis, with 1-, 2- and 4-year survivals of 25%, 9%, and 6% (median 6.5 months), respectively, compared with 75%, 47%, and 24% in their resectable counterparts (median 21 months, p < 0.0001). Conclusions: Surgical palliation continues to play an important role in the management of periampullary carcinoma. In this high-volume center, 33% of patients undergoing operative management of this disease were unresectable. Surgical palliation can be accomplished with acceptable perioperative mortality (3.1%) and morbidity (22%), with excellent longterm results.

AB - Background: Advances in the nonoperative staging and palliation of periampullary carcinoma have dramatically changed the management of this disease. Currently, surgical palliation is used primarily for patients found to be unresectable at the time of laparotomy performed for the purpose of determining resectability. Study Design: A review of all patients undergoing operative management for periampullary adenocarcinoma at a single, high- volume institution was performed. The review focused on patients found to be unresectable who, therefore, underwent surgical palliation. Results: Between December 1991 and December 1997, 256 patients with unresectable periampullary adenocarcinoma were operatively palliated. During the same time period, 512 patients underwent pancreaticoduodenectomy (PD) for periampullary carcinoma. Sixty-eight percent of patients were unresectable secondary to liver metastases or peritoneal metastases, and 32% were deemed unresectable because of local vascular invasion. Of the 256 patients, 51% underwent double bypass (hepaticojejunostomy [HJ] and gastrojejunostomy [GJ]), 11% underwent HJ alone, 19% underwent GJ alone, and 19% did not undergo any form of bypass. Celiac block was performed in 75% of patients. Palliated patients were significantly younger, with a mean age of 64.0 years compared with 65.8 years in the resected group (p = 0.04). Gender and race distributions were similar in the 2 groups, with 57% of palliated patients and 55% of resected patients being men (p = NS) and 91% of patients in each group being Caucasian (p = NS). Palliative procedures were performed with a mortality rate of 3.1%, compared to 1.9% in those successfully resected (p = NS). Those undergoing operative palliation had a significantly lower incidence of postoperative complications when compared with those undergoing pancreaticoduodenectomy (22% versus 35%, p<0.0001) and had significantly shorter lengths of stay (10.3 days versus 14.8 days, p < 0.0001). As expected, palliated patients had a significantly poorer prognosis, with 1-, 2- and 4-year survivals of 25%, 9%, and 6% (median 6.5 months), respectively, compared with 75%, 47%, and 24% in their resectable counterparts (median 21 months, p < 0.0001). Conclusions: Surgical palliation continues to play an important role in the management of periampullary carcinoma. In this high-volume center, 33% of patients undergoing operative management of this disease were unresectable. Surgical palliation can be accomplished with acceptable perioperative mortality (3.1%) and morbidity (22%), with excellent longterm results.

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