Periampullary cancer treatment in U.S. Department of Veterans Affairs hospitals: 1987-1991.

Overview

BACKGROUND: Reported treatment outcomes for painless jaundice caused by ampullary, distal biliary, or duodenal (ABD) cancer are better than those caused by pancreatic cancer. METHODS: Outcomes after resection, bypass, or biliary intubation were compared in 432 patients with ABD cancer and 1753 with periampullary pancreatic cancer from U.S. Veterans Affairs hospitals. Computer and tumor registrar records from 1987 to 1991 were compiled; follow-up to death was complete in more than 93%. RESULTS: Operative mortality and complication rates were similar for each diagnosis. Adenocarcinomas staged from registrar reports (179 ABD, 571 pancreatic) exhibited significantly longer mean survival time (analysis of variance; p < or = 0.03) in patients with ABD for all stage groupings (localized, node involvement, metastatic) when stratified by treatment. After localized cancer resection, projected 5-year survival rate was 30% in 58 patients with ABD and 6% in 64 with pancreatic cancer. However, mean survival rates were similar with or without resection when nodes were involved. No 5-year survivors were projected after resection with nodal or distant metastases. CONCLUSIONS: Patients with ABD had a longer mean survival time than those with pancreatic adenocarcinoma, and this difference persisted when studied by TNM stage. The curative potential of resection was confined to patients without nodal involvement.