Clinical and pathologic correlations in patients with periampullary tumors
F. M. Martin, R. L. Rossi, V. Dorrucci, M. L. Silverman and J. W. Braasch
Department of Surgery, Lahey Clinic Medical Center, Burlington, Mass. 01805.
Perioperative data on 87 patients undergoing pancreatoduodenectomy for
periampullary tumors were correlated with pathologic study of operative
specimens to identify the accuracy of diagnosis and the factors affecting
survival. Accuracy of endoscopic retrograde cholangiopancreatography and
computed tomography in locating lesions was 75% and 44%, respectively.
Histologic diagnosis before or at the time of resection was available in
only 61% of the patients. Carcinoma was correctly diagnosed clinically by
the pathologist or the surgeon in 95% (83/87) of patients with 4 patients
found to have benign disease on final pathologic examination.
Intraoperative diagnosis of site of origin was incorrect in 18% (16/87) of
patients. In 28% (23/83) of patients, pathologists identified nodal
metastatic disease missed by the surgeon. Survival correlated with nodal
and margin status and tumor grade. Tumor size demonstrated no predictive
capacity. Although preoperative diagnostic accuracy is less than optimal,
surgeons can usually diagnose malignant lesions but more often fail to
identify tumor origin and nodal disease. We continue to advocate resection
for patients with periampullary lesions thought to be malignant and
resectable without a positive histologic diagnosis.
