[The palliative surgery of periampullary neoplasms. Our experience]

The increased incidence of peri-ampullar neoplasia and the low percentage of cases in which radical surgery is possible fuel interest in the use of palliative treatment for this pathology. The authors report their 10-year experience of palliative surgery for peri-ampullar cancer and evaluate immediate and long-term results. Between January 1980 and December 1990 the authors operated 91 patients with peri-ampullar carcinoma (head of the pancreas, Vater's ampulla, terminal choledochus). Eight (9%) underwent radical surgery and 83 (91%) underwent palliative surgery. The distribution of cases according to tumour origin in the latter group was as follows: head of the pancreas 60 cases (72%); intra-pancreatic choledochus 13 (16%); Vater's ampulla 10 (12%). The most frequent symptoms were pain (70%) and jaundice (63%). The mean interval between the appearance of symptoms and diagnosis was 1 month (range: 5 days-12 months). The most frequently performed biliodigestive derivative surgery was cholecystojejunostomy (72% of cases). Complications were observed in 18% of cases. Mortality was 12%. Mean survival was 5 months (range: 2-43 months). The recent use of endoscopic techniques for the treatment of jaundice in patients with inoperable peri-ampullar carcinoma now requires prospective studies to compare these techniques with surgery.