Operative strategie bei periampullarem karzinom und ikterus

Periampullary carcinomas usually present with jaundice. This group of tumors includes cancers that originate within the ampullary tissues (papilla, distal common bile duct, duodenum) and periampullary pancreatic cancers. Because of differences in tumor biology, the ampullary cancers have a better prognosis than periampullary pancreatic cancers. Therefore, the differentiation between these tumors is relevant. A careful preoperative assessment excludes patients that have no surgical options. The pathophysiologic changes induced by the obstructive jaundice increase the operative risk and the morbidity, and a preoperative endoscopic bile crainage seems indicated. Resection with curative intention is the best surgical treatment of periampullary cancers presenting with obstructive jaundice. The mortality and morbidity of duodenopancreatectomies for periampullary carcinomas are low in specialized centers.