What is periampular cancer

Periampullary adenocarcinoma: chemotherapy with limited effects

Liverpool - Although carcinomas at the joint exit of the biliary and pancreatic ducts are often discovered early, the prognosis is poor even after a complete resection. A randomized clinical study in the US-American Ärzteblatt (JAMA 2012; 308: 147-156) now shows for the first time an effect for adjuvant chemotherapy, which, however, was modest and only reached the level of significance after a multivariate analysis.

Most periampullary adenocarcinomas are still small when they are discovered as a result of the discomfort caused by a blockage of the biliary and / or pancreatic duct. Around 80 percent of tumors can be resected (30 to 40 percent of all resected pancreatic head carcinomas are due to periampullary adenocarcinoma).

Because of the frequent involvement of the regional lymph nodes, radical Whipple surgery is usually carried out, sometimes with preservation of the pylorus. However, it alone cannot change the fate of many patients. The European Study Group for Pancreatic Cancer, in which clinics in Japan, Australia and Canada also participated, examined for the first time in a larger group of patients whether chemotherapy improves the prognosis.

The 428 patients were randomized to three study arms after surgery, in which they were either only observed or received chemotherapy with fluorouracil or gemcitabine. As John Neoptolemos from the University of Liverpool reports, 61 percent of patients died after less than 5 years in the observation arm, compared with 58 percent in the fluorouracil arm (plus folinic acid) and 52 percent in the gemcitabine arm.

The mean survival time was increased from 35.2 months in the observation arm to 43.1 months under chemotherapy. However, the difference was only significant after a multivariate analysis. She corrected inequalities that had existed in the age of the patients, in the proportion of bile duct carcinoma, in tumor differentiation and in the lymph node status.

This statistical trick in a non-blinded study is likely to limit the validity of the study, which, according to Neoptolemos, has shown for the first time an advantage of chemotherapy in periampullary adenocarcinoma. The authors hope that further studies will confirm the results and that combination chemotherapy will lead to better results. © rme / aerzteblatt.de