Abstracts
1998 Digestive Disease Week

#1022

REEXPLORATION FOR PERIAMPULLARY CARCINOMA: RESECTABILITY, PERIOPERATIVE RESULTS, PATHOLOGY AND LONG-TERM OUTCOME. T A Sohn, KD Lillemoe, JL Cameron, H A Pitt, J Huang, RH Hruban, CJ Yeo. Dept of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD.

Many patients are referred to tertiary centers with periampullary carcinoma after having been deemed unresectable at previous laparotomy. In carefully selected patients, it is often possible to resect these tumors; however, the perioperative results and long-term outcome have not been well defined. Methods: Between November 1991 and December 1996 inclusive, 58 patients who underwent previous exploratory laparotomy and/or palliative surgery for suspected periampullary carcinoma underwent reexploration. The operative outcome, resectability rate, pathology and long-term survival were compared to 507 concurrent patients who had not undergone previous exploratory surgery. Results: Forty of the 58 patients (69%) undergoing reexploration were successfully resected via pancreaticoduodenectomy while the remaining 18 patients (31%) were deemed unresectable. Compared to the 507 patients who had not undergone recent related surgery, the reoperative group was similar with respect to age, gender, race and resectability rate (69% vs 71%). The distribution of resectable periampullary cancers by site in the reoperative group was 63%, 20%, 15% and 2% for pancreatic, ampullary, distal bile duct and duodenal tumors respectively. This spectrum compared to 67%, 13%, 15% and 5% for the non-reoperative group (p=NS). There was no difference in the intraoperative blood loss or transfusion requirements, but the mean operative time was 7.7 hours which was significantly longer than in the control group (mean=6.8 hours; p<0.0001). On pathologic examination, the percentage of patients with positive lymph nodes was significantly less
(48% vs 67% p=0.01) in the reoperative group. The tumor diameter and incidence of positive margins were similar between the two groups. There were no differences in postoperative lengths of stay, complication rates or perioperative mortality (reoperative=1.8% vs. non-reoperative=1.7%). The long-term survival was similar between the two resected groups, with a median survival of 22 months in the reoperative group compared to 20 months in those without previous exploration (p=0.22). Conclusions: These data demonstrate that patients undergoing reoperation for periampullary carcinoma have a similar resectability rate, perioperative morbidity and mortality, and long-term survival as patients undergoing initial exploration. The results suggest that selected patients, considered unresectable at previous surgery, should undergo restaging and reexploration at specialized high-volume centers.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.