[Carcinoma of Vater's ampulla and precursor states]

Treatment of periampullar carcinoma is known to be more rewarding than that of the cancer of pancreas. Operative mortality however remains high, and five-year survivors are a minority. Diagnosis of precancerous lesions should improve the prevention of these tumours. We review our ten-year experience, in which 16 periampullary carcinomas were operated on in patients aged between 45 and 90 years (average 69). 10 Whipple and 3 local resections, and 3 by-pass procedures were performed. Two patients died during the first two postoperative weeks, after a Whipple and a by-pass procedure respectively. Survival after the Whipple operations averaged 35 months (3 patients are still alive up to 60 months later) and 9.9 months after the other procedures. All the histologic specimens were reviewed for lesions such as adenomatous polyps or epithelial dysplasias coexisting with carcinoma. We found such associations in 3 biopsies or local excisions and in 4 pancreaticoduodenal resections. These findings confirm that periampullar carcinoma is preceded in a significant number of cases by pre-malignant conditions. It is hoped that awareness of this fact will make possible early diagnosis and treatment.