The records of 143 patients with periampullary carcinoma were reviewed. Patients treated by resection lived an average of 25.0 months; those treated by bypass survived only 5.5 months. No patient with carcinoma other than ampullary survived five years. Bypass procedures and resections had similar operative mortalities (19% vs 20%). The average symptom-free period for patients undergoing bypass was 2.9 months, whereas for those undergoing resection it was 19.6 months. For pancreatic carcinoma, the symptom-free period was 8.0 months after resection and 2.8 months after bypass.
Although the two groups of patients are not strictly comparable, the data and considerations of quality of life suggest that resection should be attempted whenever possible. Effective palliation is more likely to be achieved by resection than bypass. Empiric duodenal and biliary decompression do not appear to be justified. Absolute indications for bypass are biliary sepsis, gastric outlet obstruction, and intractable pruritus.
Wilson SM, Block GE. Periampullary Carcinoma. Arch Surg. 1974;108(4):539-544. doi:10.1001/archsurg.1974.01350280141023