Reoperative surgery for periampullary adenocarcinoma
G. E. McGuire, H. A. Pitt, K. D. Lillemoe, J. E. Niederhuber, C. J. Yeo and J. L. Cameron
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.
In recent years, the morbidity, mortality, and long-term survival of
patients undergoing surgery for periampullary adenocarcinoma have improved.
These changes have prompted us to reoperate on patients who have previously
undergone pancreatobiliary surgery, many of whom were initially considered
to have unresectable lesions. From 1979 to 1990, 38 patients with
pancreatic and 17 patients with nonpancreatic periampullary adenocarcinoma
underwent reexploratory surgery at The Johns Hopkins Hospital, Baltimore,
Md. Thirty-three (60%) of these 55 patients had resection at the time of
second laparotomy. Of the 46 patients undergoing reexploratory surgery with
an intent to resect, the overall resection rate was 72% (33), 64% (16/25)
for pancreatic and 100% for nonpancreatic periampullary adenocarcinoma.
Postoperative complications occurred in 21 patients (38%), but only one
patient (2%) died following surgery. Mean survivals from reexploratory
surgery were 6.9 months for the 22 patients with pancreatic cancer
undergoing palliative surgery, 20.5 months for the 16 patients with
resectable pancreatic cancer, and 33.0 months for the 17 patients with
nonpancreatic periampullary adenocarcinoma undergoing resection. We
conclude that in carefully selected patients, reoperative surgery for
periampullary cancer (1) provides a significant resection rate, (2) can be
performed safely, and (3) offers a chance for long-term survival.
