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Periampullary_Carcinoma

Periampullary_Carcinoma - Periampullary Carcinoma and The...

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Periampullary Carcinoma and The Whipple Vic Vernenkar, D.O. St. Barnabas Hospital Bronx, NY
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Endoscopic View
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Pathology Adenocarcinoma accounts for 95% Arises from 4 different tissues of origin Head of pancreas Distal Bile duct Ampulla of Vater Periampullary duodenum
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Pathology Prognosis for each of these are different. Five year survival for pancreas: 18% Five year for ampulla: 36% Five year for distal bile duct: 34% Five year for duodenum: 33% Determination of tissue origin is important for prognosis, extent of resection.
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Pathology Determination of tissue origin from FNA, endoscopic biopsy. Also from thin section CT scan, ERCP Determination of k-Ras also helps (95% of pancreatic cancer).
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Spread Locoregional spread results from lymphatic invasion and direct tumor spread to adjacent soft tissue. Ampullary lesions spread to LN 33%, typically to a single LN in the posterior pancreatcoduodenal group. Duodenal has intermediate spread. Pancreas metastasizes 88% to multiple sites.
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Treatment Standard Whipple pancreaticoduodenectomy thought to provide adequate tumor clearance in the case of non-pancreatic ampullary tumor, because tumor spread is localized. Biopsy proven paraduodenal LN is thought by most to preclude curative resection
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Surgery and Chemotherapy Retrospective review of 41 patients identified low risk and high risk patients determined by pathology.
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