Periampullary cancers - Are there differences?

This review supports the clinical impression that periampullary cancers var y in outcome after resect ion. Overall survival after pancreaticoduodenecto my is greatest for patients with ampullary and duodenal cancers, intermedia te for patients with bile duct cancer, and least for patients with pancreat ic cancer. Moreover, survival for each tumor stage is greater for nonpancre atic periampullary cancers than for pancreatic cancers. Invasion of the pan creas by nonpancreatic periampullary cancers is a major factor adversely af fecting survival. Recent data suggest that that inherent differences in tum or biology rather than embryonic, anatomic, or histologic factors probably account for these differences in survival. Finally, although pancreaticoduo denectomy remains the procedure of choice for resectable periampullary canc ers, further increases in survival will likely evolve through more effectiv e neoadjuvant or adjuvant therapies rather than modifications in the surgic al approach.