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Type: Journal article
Title: Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy
Author: Chandrasegaram, M.
Chiam, S.
Chen, J.
Khalid, A.
Mittinty, M.
Neo, E.
Tan, C.
Dolan, P.
Brooke-Smith, M.
Kanhere, H.
Worthley, C.
Citation: World Journal of Surgical Oncology, 2015; 13(1):85-1-85-7
Publisher: BioMed Central
Issue Date: 2015
ISSN: 1477-7819
Statement of
Manju D Chandrasegaram, Su C Chiam, John W Chen, Aisha Khalid, Murthy L Mittinty, Eu L Neo, Chuan P Tan, Paul M Dolan, Mark E Brooke-Smith, Harsh Kanhere and Chris S Worthley
Abstract: BACKGROUND: Pancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD. METHODS: A retrospective review of PD between January 2000 and December 2012 at a public metropolitan database was performed. The institutional ethics committee approved this study. RESULTS: There were 142 PDs during the study period, of which 70 cases were pre-2010 and 72 post-2010, corresponding to a recent increase in the number of cases. Of the 142 cases, 116 were for periampullary cancers. There were also proportionately more PD for PC (26/60, 43% pre-2010 vs 39/56, 70% post-2010, P = 0.005). There were 65/116 (56%) pancreatic, 29/116 (25%), ampullary, 17/116 (15%) biliary and 5/116 (4%) duodenal cancers. Nodal involvement occurred more frequently in PC (78%) compared to ampullary (59%), biliary (47%) and duodenal cancers (20%), P = 0.002. Perineural invasion was also more frequent in PC (74%) compared to ampullary (34%), biliary (59%) and duodenal cancers (20%), P = 0.002. Microvascular invasion was seen in 57% pancreatic, 38% ampullary, 41% biliary and 20% duodenal cancers, P = 0.222. Overall, clear margins (R0) were achieved in fewer PC 41/65 (63%) compared to ampullary 27/29 (93%; P = 0.003) and biliary cancers 16/17 (94%; P = 0.014). CONCLUSIONS: This study highlights that almost half of PD was performed for cancers other than PC, mainly ampullary and biliary cancers. The volume of PD has increased in recent years with an increased proportion being for PC. PC had higher rates of nodal and perineural invasion compared to ampullary, biliary and duodenal cancers.
Keywords: Pancreatic cancer; Ampullary cancer; Biliary cancer; Duodenal cancer; Periampullary cancer; Margin; Pancreaticoduodenectomy; Histopathology; Whipple
Rights: © 2015 Chandrasegaram et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI: 10.1186/s12957-015-0498-5
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