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Background: Periampullary carcinoma, which includes ampullary carcinoma, pancreatic head cancer, distal common bile duct cancer, and duodenal papillary cancer, is a relatively rare malignancy with uncertain therapeutic options. Although several studies have investigated the efficacy of multiple adjuvant chemotherapy regimens for periampullary carcinoma treatment, the optimal regimen remains to be determined. The inherent heterogeneity of the mucosal origin divides periampullary carcinoma into intestinal and pancreaticobiliary types. Therefore, the selection of chemotherapy regimens based on pathological type may have potential therapeutic significance. Case Presentation: A 72-year-old woman with moderately differentiated periampullary adenocarcinoma experienced disease progression after receiving FOLFOX regimen. Subsequently, the sample was subtyped first by H&E evaluation and then by the evaluation of an IHC panel composed of CK20, CDX2, MUC1, MUC2, and MUC5AC. The pathologists concluded that the patient's sample was of the pancreaticobiliary (PB) subtype. The subsequent change to gemcitabine plus S-1 adjuvant therapy achieved remission of liver metastases based on the pathological classification of the cancer. Conclusion:Based on the pathological classification, adjuvant chemotherapy with gemcitabine may be beneficial for patients with PB subtype periampullary carcinoma. 5-Fu-based adjuvant chemotherapy may be beneficial for patients with intestinal subtype periampullary carcinoma.

Background: Laparoscopic transcystic common bile duct exploration (LTCBDE) is the minimally traumatic surgical method for the treatment of choledocholithiasis secondary to cholecystolithiasis with dilated common bile duct (CBD). However, no report exists concerning LTCBDE in patients with nondilated CBD. The purpose of this study was thus to explore the safety, efficacy, and feasibility of LTCBDE in patients with choledocholithiasis secondary to cholecystolithiasis with nondilatation of the CBD.Methods: We retrospectively analyzed 47 patients with choledocholithiasis secondary to cholecystolithiasis who were treated with LTCBDE at the Second Affiliated Hospital of Nanchang University from January 2017 to August 2021 (all the patients had undergone endoscopic retrograde cholangio-pancreatography treatment, but this failed due to various reasons). Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction, and surgical outcomes were collected and reviewed. Each patient was followed up for more than 3 months.Results: There were 47 patients in this study, including 21 females and 26 males, with their ages ranging from 15 to 82 years (51±15 years). All patients were treated with surgery, and the CBD stones were removed successfully. Among these patients, 45 underwent LTCBDE for the removal of stones in the CBD, with failure occurring in 2 patients who then accepted laparoscopic common bile duct stone removal (LCBDE) + T tube drainage. The diameter of the cystic duct was 0.30-0.73 cm (0.60±0.07 cm), the diameter of the CBD was 0.60-0.80 cm (0.73±0.05 cm), the operation time was 75-220 minutes (159±33 minutes), and the postoperative hospital stay was 2-13 days (6±2 days). None of the patients experience any serious postoperative complications, and all were discharged safely. During the follow-up, no postoperative biliary stenosis, bile leakage, or other complications occurred.Conclusions: LTCBDE is feasible to treat patients with choledocholithiasis secondary to cholecystolithiasis with nondilatation of the CBD. This choice of treatment plan reduces the length of hospital stay and the occurrence of postoperative complications. However, it is recommended that this be attempted on the basis of the experience of LTCBDE with dilated CBD.

Background Pancreaticoduodenectomy (PD) is the main curative treatment for periampullary carcinoma (PAC), but the high risk of complications in PD means an accurate preoperative diagnosis is essential, because benign lesions can be treated without PD. Despite as the preferred diagnosis method, preoperative endoscopic biopsy is characterized with high false-negative rate, which disturbs the making of surgical plans. We explored the degree of matching between preoperative and postoperative pathological diagnoses, analyzed the shortcomings of endoscopic biopsy, and provide recommendations for the diagnosis and treatment of periampullary tumors. Methods We retrospectively analyzed 198 patients with periampullary tumors who underwent endoscopic biopsy and PD between June 2013 and February 2021. Data on disease characteristics, such as sex, age, total bilirubin (TBIL), direct bilirubin (DBIL), tumor markers, imaging features, preoperative and postoperative pathology were collected and reviewed. The measurement data with normal distribution were expressed by mean ± standard deviation, and the categorical data were expressed by the number of cases. Results In our cohort, 196 patients (98.99%) were diagnosed with PAC based on postoperative pathology. Preoperative pathological biopsy was performed in 198 patients with dysplasia (n=76), inflammation (n=7), and PAC (n=115), among whom 111 were diagnosed with PAC at the first biopsy and 4/7 at the second biopsy. The false-negative rate for one preoperative biopsy was 85/196 (43.37%); 74/76 (97.37%) patients in the dysplasia subgroup and 7/7 (100%) patients in the inflammation subgroup showed malignant results after surgery. Conclusions Preoperative endoscopic biopsy has a high false-negative rate. Multiple sites, greater depth, and more biopsies may increase accuracy. Patients preoperatively diagnosed with dysplasia have a high risk for cancer and are recommended to undergo PD directly.

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