The importance of tumour volume in the prognosis of radically treated periampullary carcinomas.

OBJECTIVE: To assess the influence of tumour volume on clinicopathological findings and survival time after radical operation for periampullary carcinoma. DESIGN: Retrospective study. SETTING: Kaiser-Franz-Josef-Hospital, Vienna, Austria. SUBJECTS: 72 of 75 consecutive patients who underwent pancreaticoduodenectomy for periampullary carcinoma between 1 January 1979 and 31 December 1991. OUTCOME MEASURES: Cancers were divided into four groups according to volume (mm3) and the incidence of lymph node involvement, infiltration of surrounding tissues and of visceral vessels, and histologically non-radical resections were calculated, as was the length of survival after resection. RESULTS: There were 22 tumours with a volume of 0-2500 mm3 (group 1), 12 with a volume of 2,501-5,000 mm3 (group 2), and 19 each in groups 3 (5,0001-10,000 mm3) and 4 (more than 10,000 mm3). All carcinomas of the common bile duct (n = 5) and the papilla of Vater (n = 18) were in groups 1 and 2, whereas 38 of the 49 carcinomas of the head of pancreas were in groups 3 and 4. Lymph nodes were involved in 3 (14%), 6 (50%), 13 (68%) and 14 (74%); the surrounding tissues were infiltrated in 6 (27%), 8 (67%), 11 (58%) and 12 (63%); the main visceral vessels were involved in 0, 3 (25%), 5 (26%) and 8 (42%); and the resections were histologically not radical in 0, 2 (17%), 7 (37%) and 9 (47%), respectively. There was significant negative correlation (p < 0.0001) between tumour mass and survival. CONCLUSIONS: These results explain at least in part the poorer prognosis after radical resection of carcinoma of the head of the pancreas.