Medline ® Abstract for Reference 32
of 'Ampullary carcinoma: Epidemiology, clinical manifestations, diagnosis and staging'
Blind Whipple resections for periampullary and pancreatic lesions.
Camp ER, Vogel SB
Am Surg. 2004;70(1):6.
Many patients with periampullary mass lesions lack a tissue diagnosis at referral despite advances in body imaging and aggressive biopsy techniques. This review evaluates a consecutive cohort of patients who underwent pancreatoduodenectomy (PD) with and without a diagnosis of malignancy. From 1990 to 2001, 121 patients underwent PD on a gastrointestinal surgical service by a single surgeon with a bias toward "blind" Whipple resections (BWR). Sixty-three per cent of the patients had obstructive jaundice with a mass on CT in 51 per cent. Fifty-three patients (44%) had a preoperative diagnosis of malignancy. Sixty-eight patients (56%) underwent a blind PD based on computed tomography (CT), ERCP, and clinical findings. After PD, 113 patients (94%) had a malignancy (46 pancreatic, 30 ampullary, 13 cholangiocarcinoma, 9 neuroendocrine, 4 duodenal, 10 other). Of the 68 patients (56%) who underwent a blind PD, 61 patients (90%) had a malignancy. Ten per cent of the BWR patients had a pathologic diagnosis of chronic inflammation/pancreatitis. Overall mortality was 3.3% (4 patients), with no deaths in the BWR group. In this review, clinical judgment was correct in 90 per cent of patients undergoing a "blind" PD without a prior diagnosis of malignancy. In patients with "potentially resectable" lesions (based on CT exam), biopsy information does not affect the choice of therapy since a negative biopsy still commits the patients tosurgery. Combined CT and/or ERCP data with clinical findings leads most often to a correct diagnosis and procedure. These data question the practice of numerous biopsy attempts in patients with periampullary lesions.
Department of Surgery, Division of Gastrointestinal Surgery, University of Florida, College of Medicine, Gainesville, Florida 32610-0286, USA.