Extended local resection for treatment of periampullary carcinoma of vater.

BACKGROUND: The trauma caused by pancreatoduodenectomy for periampullary carcinoma of vater is often severe and extensive. The purpose of this study was to evaluate the effect of extended local resection in the treatment of periampullary carcinoma of vater. METHODS: The extra-hepaticobiliary tract, the confluence of the pancreatic and biliary duct, vater ampulla and duodenal papilla were resected en bloc in 8 patients with periampullary carcinoma from 1995 to 1998. RESULTS: One patient died perioperatively. Duodenal obstruction developed postoperatively in one of 7 survived patients and was relieved after reoperation. All the 7 patients were followed up for more than 6 months without recurrence. CONCLUSION: Extended local resection fulfils the task of radical treatment of periampullary malignancy.

Surgical treatment for uncinate process carcinoma of the pancreas.

OBJECTIVES: To analyze the clinical features of uncinate process carcinoma of the pancreas and to improve the resection rate. METHODS: From January 1990 to June 1999, 10 patients with pancreas uncinate process carcinoma received Whipple's operation. Portal vein (PV) resection and reanastomosis were performed in 5 patients, and the resected length varied from 2.0 to 4.2 cm. Two patients underwent PV lateral wall partial resection. RESULTS: Among the 7 patients undergoing PV resection, 1 died of hepatic failure 3 days after operation. One patient suffered from postoperative chylous ascites. These 6 patients survived 13 to 29 months postoperatively. Among the 3 patients without PV resection, 2 survived 13 months and 14 months respectively. One patient was alive by the end of follow-up for 11.5 months postoperatively. CONCLUSION: Although uncinate process carcinoma of the pancreas has a tendency to invade the adjacent PV and superior mesentery vein, it should not be simply regarded as a contraindication of radical resection.