Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988
Article Abstract:
The ampulla of Vater is a dilatation where the bile duct meets the pancreatic duct before emptying into the small intestine. After surgical removal, patients with cancers of the ampulla have a significantly higher survival rate than patients with cancers of the nearby pancreatic duct. Unfortunately, it is not always easy to clinically distinguish between ampullary adenocarcinoma and a pancreatic ductal carcinoma of the nearby area. This problem is compounded by the fact that cancers of the ampulla are uncommon, and published reports often lump them together with cancers of the pancreatic ducts, giving a misleading impression of incurability. The prognosis of pancreatic ductal cancer is sufficiently grim that the usual treatment is only palliative. Proper diagnosis is therefore critical; the mistaken diagnosis of an ampullary cancer as pancreatic ductal cancer will likely result in potentially curative treatment being withheld from a patient. In order to provide more information on these uncommon cancers, the authors compiled data from 24 patients with cancer of the ampulla seen over a 35-year period. Overall, the actuarial survival following surgery for cancer of the ampulla was 61 percent. However, the radical removal of the pancreas and duodenum, which is necessary to achieve this cure, is a serious operation, and the overall mortality from the surgery was 12.5 percent. When the 35-year period was broken down, it was found that in the more recent years the mortality from the surgery has dropped to about 6.3 percent. Unfortunately, the diagnosis of ampullary adenocarcinomas is far from satisfactory, with some reports indicating a correct preoperative diagnosis from 18 to 25 percent of the time. A recent report claims that improvements in endoscopic and imaging techniques can raise this accuracy to 70 percent. Nevertheless, rather than fail to treat a potentially curable cancer, surgical resection should be considered for all cases in which this diagnosis is uncertain . (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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Patterns of failure after curative resection of pancreatic carcinoma
Article Abstract:
Pancreatic cancer accounts for three percent of the all cancers in the US, but five percent of all cancer deaths. Furthermore, the incidence of pancreatic cancer has been on the rise. Even patients with pancreatic cancer that seems to be completely removable by surgery have a 5-year survival rate which varies from 0 to 18 percent. To evaluate the causes of treatment failure in patients with surgically resectable pancreatic cancer, the records of 36 patients were reviewed. Twenty-six patients developed recurrent disease. In 7 of these, or 27 percent, the only recurrence was local. However, a total of 70 percent of patients had some local recurrence. In 50 percent of the patients, spread to the liver had occurred, and in 31 percent there were metastases in the peritoneal cavity. Only 27 percent had metastatic disease outside the peritoneal cavity. Six patients are currently alive with no evidence of disease; four patients in the study died without evidence of disease and due to causes unrelated to their cancer. This study paints a bleak picture of pancreatic cancer. Only 10 percent of patients with pancreatic cancer have disease which might be cured by surgery. However, among these only a small minority will escape recurrent disease of either local and/or distant metastases. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
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