The role of pancreaticoduodenectomy for locally recurrent or metastatic carcinoma to the periampullary region.

BACKGROUND

The efficacy of operative resection of metastatic lesions to the liver, lung, and brain is well established. However, the appropriate management of metastatic or locally recurrent malignancies to the periampullary region is less well established.

STUDY

DESIGN

A retrospective review of The Johns Hopkins Hospital experience with pancreaticoduodenectomy for metastatic or locally recurrent periampullary lesions was performed.

RESULTS

From 1988 to 1993, 27 patients with a past history of malignancy underwent pancreaticoduodenectomy. In six patients (22 percent), the lesion was determined to be from a metastasis or a local recurrence, and in 21 patients (78 percent), the lesion was a new primary. Patients with metastatic or locally recurrent lesions were younger (51.3 compared to 67.1 years of age) and presented with a shorter interval from their initial neoplasm (33 compared to 120 months). Of the six patients undergoing pancreaticoduodenectomy for a metastatic or locally recurrent lesion, three patients are alive an average of 38 months and three patients died an average of 11 months postoperatively. This compares favorably with the survival rate of the new primary group in which 12 patients are alive a mean of 22 months and nine patients died a mean of 14 months postoperatively.

CONCLUSIONS

These results suggest that patients with metastatic or locally recurrent lesions in the periampullary region from a previously treated neoplasm should be considered candidates for pancreaticoduodenectomy.