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Is Blind Pancreaticoduodenectomy Justified for Patients with Ampullary Neoplasms?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Many specialists justify pancreaticoduodenectomy (PD) for pancreatic head neoplasms with suspected but unproven malignance (blind-PD). Our aim in this study was to determine whether blind-PD is also justified for ampullary neoplasms.

Methods

We retrospectively reviewed the records of all patients with presumed resectable ampullary neoplasms treated at the National Taiwan University Hospital from 1998 to 2008.

Results

Of the 84 patients without a preoperative tissue diagnosis of malignance, 64 had blind-PD and 20 had ampullectomy (AMP) with intraoperative frozen section. Patients with jaundice, gastrointestinal bleeding, imaging findings showing tumor invasion, and larger tumor size were significantly more frequently treated by blind-PD. Final pathological diagnosis was benign in ten of 64 blind-PD-treated patients.

Conclusions

Our data support a selective use of blind-PD because (1) a significant portion (65%) of benign ampullary neoplasms can be safely and effectively treated by AMP, (2) blind-PD does not treat ampullary cancer at earlier stage, and (3) blind-PD is associated with significantly more complications and significantly longer hospital stay than AMP. However, blind-PD is strongly recommended for patients with large ampullary neoplasms (>3 cm in diameter), with jaundice, or with malignant endoscopic appearance.

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Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China

    Yu-Wen Tien, Chi-Chuan Yeh, Rey-Heng Hu & Po-Huang Lee

  2. Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China

    Shi-Po Wang

  3. Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 10002, Taiwan, Republic of China

    Yu-Wen Tien

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  1. Yu-Wen Tien
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  2. Chi-Chuan Yeh
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  4. Rey-Heng Hu
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Correspondence to Yu-Wen Tien.

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Tien, YW., Yeh, CC., Wang, SP. et al. Is Blind Pancreaticoduodenectomy Justified for Patients with Ampullary Neoplasms?. J Gastrointest Surg 13, 1666–1673 (2009). https://doi.org/10.1007/s11605-009-0943-2

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  • DOI: https://doi.org/10.1007/s11605-009-0943-2

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