Advertisement

Periampullary Carcinoma

  • Heidi N. Overton
  • Matthew J. WeissEmail author
Chapter

Abstract

Periampullary adenocarcinoma (PAC) is defined as tumors arising ≤2 cm from the ampulla of Vater and can originate from the pancreatic head, duodenum, distal bile duct, or ampulla of Vater. All four subtypes of PAC typically present with obstructive jaundice but have variable survival rates depending on site and specific histology. Pancreas protocol computed tomography (CT) scan is the most useful imaging modality for PACs, and surgical resection offers the best chance of cure. Proceeding to surgery based on pancreas protocol CT findings alone is acceptable, but certain clinical scenarios may require further preoperative workup with biliary drainage procedures or tissue diagnosis. The standard procedure for PAC is pancreaticoduodenectomy (PD) with the goal of complete tumor resection with negative oncologic margins. Clinicopathologic staging is based on the American Joint Committee on Cancer (AJCC) Cancer Staging Manual for each location of PAC origination. Key factors in staging and adjuvant treatment are resection margins, nodal involvement, microvascular invasion, and perineural invasion. Features important for chemotherapy and immunotherapy include histomolecular markers such as key results areas (KRAS) and ductal pancreatic adenocarcinoma (DPAC) that offer opportunity for targeted therapy. Multidisciplinary oncologic care for PAC is essential along the continuum of treatment.

Keywords

Periampullary carcinoma Ampullary carcinoma Distal bile duct carcinoma Duodenal adenocarcinoma Pancreatic ductal adenocarcinoma Pancreas protocol computed tomography scan Pancreaticoduodenectomy Biliary drainage procedure Neoadjuvant therapy Adjuvant therapy 

References

  1. 1.
    Sarmiento JM, Nagorney DM, Sarr MG, Farnell MB. Periampullary cancers: are there differences? Surg Clin North Am. 2001;81(3):543–55.CrossRefGoogle Scholar
  2. 2.
    He J, Ahuja N, Makary MA, Cameron JL, Eckhauser FE, Choti MA, et al. 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB [Internet]. 2014;16(1):83–90. Available from: 10.1111/hpb.12078.CrossRefGoogle Scholar
  3. 3.
    Siegel R, Miller K, Jemal A. Cancer statistics, 2015. CA Cancer J Clin [Internet]. 2015;65(1):29. Available from: http://onlinelibrary.wiley.com/doi/10.3322/caac.21254/pdf.Google Scholar
  4. 4.
    Riall TS, Cameron JL, Lillemoe KD, Winter JM, Campbell KA, Hruban RH, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery. 2006;140(5):764–72.CrossRefGoogle Scholar
  5. 5.
    Westgaard A, Tafjord S, Farstad IN, Cvancarova M, Eide TJ, Mathisen O, et al. Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer [Internet]. 2008;8(1):170. Available from: http://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-8-170.CrossRefGoogle Scholar
  6. 6.
    Godellas CV. In: Saclarides TJ, Millikan KW, Godellas CV, editors. Surgical oncology: periampullary malignancies. New York: Springer; 2003. p. 282–99.CrossRefGoogle Scholar
  7. 7.
    Cooper M, Newman NA, Ibrahim AM, Lam E, Herman JM, Singh VK, et al. Unnecessary tests and procedures in patients presenting with solid tumors of the pancreas. J Gastrointest Surg. 2013;17(7):1218–23.CrossRefGoogle Scholar
  8. 8.
    Gloor B, Todd KE, Reber HA. Diagnostic workup of patients with suspected pancreatic carcinoma. Cancer. 1997;79(9):1780–6.CrossRefGoogle Scholar
  9. 9.
    House MG, Yeo CJ, Cameron JL, Campbell KA, Schulick RD, Leach SD, et al. Predicting resectability of periampullary cancer with three-dimensional computed tomography. J Gastrointest Surg. 2004;8(3):280–8.CrossRefGoogle Scholar
  10. 10.
    Scheufele F, Schorn S, Demir IE, Sargut M, Tieftrunk E, Calavrezos L, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surg (United States). 2017;161(4):939–50.Google Scholar
  11. 11.
    Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol [Internet]. 2016;14(1):182. Available from: http://wjso.biomedcentral.com/articles/10.1186/s12957-016-0933-2.CrossRefGoogle Scholar
  12. 12.
    Hartwig W, Schneider L, Diener MK, Bergmann F, Büchler MW, Werner J. Preoperative tissue diagnosis for tumours of the pancreas. Br J Surg. 2009;96(1):5–20.CrossRefGoogle Scholar
  13. 13.
    Clarke DL, Clarke BA, Thomson SR, Garden OJ, Lazarus NG. The role of preoperative biopsy in pancreatic cancer. HPB. 2004;6(3):144–53.CrossRefGoogle Scholar
  14. 14.
    Egner JR. AJCC cancer staging manual. JAMA. 2010;304:1726.CrossRefGoogle Scholar
  15. 15.
    Chandrasegaram MD, Chiam SC, Chen JW, Khalid A, Mittinty ML, Neo EL, et al. Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy. World J Surg Oncol [Internet]. 2015;13(1):85. Available from: http://www.wjso.com/content/13/1/85.CrossRefGoogle Scholar
  16. 16.
    Kumar R, Herman JM, Wolfgang CL, Zheng L. Multidisciplinary management of pancreatic cancer. Surg Oncol Clin N Am. 2013;22:21231.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA

Personalised recommendations