Review Article - Current options in the diagnosis and management of periampullary carcinoma

Periampullary cancers constitute a distinct entity compared to the classical pancreatic head cancer. Their diagnosis and the approach to their treatment has improved considerably in the last two decades. Endoscopy, high-resolution imaging, and endosonography have resulted in improved diagnosis and staging. A pancreatoduodenectomy offers the only chance of cure and improves survival. Superior results are seen with high volume centres. While endoscopy plays an invaluable role in the palliation of obstructive jaundice in unresectable lesions, its role in preoperative stenting remains uncertain. Adjuvant treatment modalities have so far failed to significantly improve survival. These tumours carry a better prognosis than the more dismal pancreatic head cancer, possibly because of the activation of different molecular pathways in the process of carcinogenesis. This article reviews the current understanding and various treatment options of periampullary carcinomas other than the classical pancreatic head cancer.

Keywords
Periampullary tumours, Pancreatoduodenectomy, Obstructive jaundice, Ampulla of vater, Bile duct