MANAGEMENT DECISIONS FOR UNUSUAL PERIAMPULLARY TUMORS

The pessimism associated with the treatment of pancreatic cancer may r esult in inappropriate management in certain patients thought to have that disease. We analyzed the recent UCLA experience with a variety of periampullary tumors in which various issues concerning management we re unusual. The records of nine patients (age 15-75 years) with pancre atic or periampullary tumors were reviewed retrospectively. The tumor was evident on CT scan in all patients. The diameter of the mass was g reater than 5 cm in five cases. Eight of the tumors appeared to arise from the pancreas, but at exploration, two were found to originate fro m other stuctures (duodenum and retroperitoneum), One patient with an apparent gastric lesion on CT scan was found to have a mass of pancrea tic origin at operation. Operative procedures included: pancreaticoduo denectomy (four), distal pancreatectomy (three), total pancreatectomy (one), and retroperitoneal tumor resection (one). Pathological diagnos es included: solid and papillary epithelial neoplasm (two), mucinous c ystic neoplasm (two), serous microcystic adenoma (two), myositis ossif icans (one), degenerative neurilemoma (one), spindle cell tumor (one), and intraductal papillary carcinoma (one). We conclude that patients with large or unusual-appearing pancreatic or periampullary tumors sho uld be managed aggressively. Major resections can be done safely with the achievement of an excellent quality of life in individuals at the extremes of age. Unlike the usual pancreatic ductal adenocarcinoma, th e prognosis for many of these neoplasms is excellent.