Periampullary carcinoma: better prognosis with early pre-stenting referral to surgery

This study was undertaken to find out reasons of delayed referral for surgical treatment and to assess the effect of delayed referral on management and prognosis of patients with periampullary carcinoma. Patients with histopathologically proved periampullary carcinoma (n=41) during the period January 2010 to December 2010 who had been admitted into the department of surgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh (BSMMU) were included in this study. Information of the patient was retrieved from medical records. Patients and relatives were interviewed for reasons of delay in seeking surgical help. Patients were divided into two groups: Group I: those who admitted to surgical unit within one month (6 days to 1 month) of noticing jaundice (n=13), and Group II: those who admitted to surgical unit after one month (1.2 months to 18 months) of noticing jaundice (n=28). Parameters were compared between two groups. Patients in group II were poor liver function and nutritional status needed more supplementary therapy in perioperative period. The incidence of distant metastasis and ascites were more frequent in Group II than Group I patients. Definitive procedure (Whipple's operation) was possible in 53.8% patients in Group I whereas only 7.1% in Group II patients (p <0.05). The reasons for delay referral to surgery were due to patient's ignorance, superstition and fear of receiving operative treatment. Delay in diagnosis of periampullary carcinoma as a cause of jaundice and immediate relief of jaundice with ERCP and stenting is another important cause of delay in seeking definitive operative treatment. Awareness of public as well as general physicians is required for early referral of patients with periampullary carcinoma to surgery. Joint assessment of these patients by Gastroenterologist and Hepatobiliary surgeons before internal biliary drainage will improve prognosis.