An Unusually Prolonged Survival in Metastatic Periampullary Pancreatic Adenocarcinoma

Abstract

Periampullary cancer is the term used for neoplasms arising from the head of pancreas, ampulla of Vater, distal bile duct and periampullary region of duodenum. Of these, the pancreatic adenocarcinoma carries the worst prognosis with majority of mortalities within the 1st year. The overall 5-year survival is <3%. Studies have shown that pancreatic carcinoma has the shortest median survival of 17.1 months of all periampullary carcinomas. With the development of metastasis, the median survival tends to reduce to 3–6 months. We are reporting a case of metastatic periampullary pancreatic adenocarcinoma that received minimal and interrupted chemotherapy due to poor tolerance and yet managed to survive far beyond the reported median survival. Key words: Adenocarcinoma, pancreas, periampullary, prognosis

Primary Duodenal Periampullary Adenocarcinoma: An Uncommon Presentation

“…In contrast, ampullary carcinomas are primarily in the region of the ampulla of Vater accounting for about 0.2% of tumors of the gastrointestinal tract [1]. Clinically, distinguishing ampullary from periampullary tumors is of high importance as this provides significance to the prognosis and resectability; ampullary carcinomas have a more desirable prognosis with five-year survival ranging from 34%-45% [1,3].…”

“…However, it has been suggested that patients with periampullary carcinoma of primary duodenal etiology who have had pancreatoduodenectomy have the longest survival at five years (53%) versus other etiologies (22%) [4]. Factors including resection to negative margins, no lymph node metastasis, and well or moderate tumor differentiation have been shown to have a positive impact on five-year survival [3]. Mortality rate after PD is currently 0%-5% in experienced (>25 procedures/year) centers but is still associated with postoperative complications -the most common of these being postoperative infections and sepsis.…”