Background: Reports of periampullary adenocarcinomas are scarce in Latin-America. Pancreatic adenocarcinoma (PA) has the highest incidence in western countries, but also worse survival compared to distal bile duct (DBD), ampullary (AA) and duodenal (DA) adenocarcinomas, even after being resected by pancreaticoduodenectomy (PD). In this study, we analyze the survival of patients with resected periampullary adenocarcinomas and determined factors that influence this outcome. Methods: We retrospectively analyzed patients undergoing PD for periampullary adenocarcinoma from 2002 to 2011 in the three major pancreatic surgery centers in Peru. Postoperative mortalities (90-day) were excluded. Clinicopathologic features that may influence overall survival (OS) were collected and analyzed by Kaplan–Meier method. Log-Rank test and Cox regression modelling were used for univariate and multivariate analysis, respectively. Results: 473 Periampullary adenocarcinomas (153 PA, 258 AA, 33 DBD and 29 DA) treated by PD were identified. 5-year OS was 34% with a median survival of 28 months for the entire cohort. PA was associated with the worst 5-year OS (11%) compared to DBD (24%), DA (41%) and AA (47%), respectively (p < 0.01). Predictors of poor survival were site of primary, age ≥ 70 years, tumor size ≥ 2.5 cm, high-grade tumors, nodal metastases, lymphovascular invasion, perineural invasion and positive resection margin. On multivariate analysis, site of primary and nodal metastases were the strongest predictors of survival. Conclusion: We report the oncologic outcomes of the largest multi-institutional series of resected periampullary adenocarcinomas in Peru and Latin-America. AA is the most frequently resected tumor and portent the best prognosis, while PA has the worst OS. Patient selection could account for differences with reports of developed countries.Table 1Univariate and multivariate analysis of predictors of OS in patients undergoing PD for periampullary adenocarcinomasVariableNumber of patients5 years OSUnivariate analysisMultivariate analysisHazzard ratio (95% CI)PHazzard ratio (95% CI)PSex Man21780(37%) Woman25679 (31%)1.1 (0.9–1.4)0.304––Age <70 years332118 (36%) ≥70 years14141 (29%)1.3 (1.1–1.7)0.0171.4 (1.1–1.8)0.008Tumor size <2.5 cm14676 (41%) ≥2.5 cm28783 (29%)1.5 (1.2–1.9)0.0011.1 (0.8–1.4)0.549Site of primary Pancreas15317 (11%)ReferenceReference Distal Bile Duct333 (24%)0.6(0.4–0.9)<0.0010.7 (0.4–1.0)0.008 Duodenum2912 (41%)0.3 (0.2–0.6)0.0080.6 (0.3–0.9)0.036 Ampulla of Vater258122 (47%)0.3 (0.2–0.4)<0.0010.5 (0.4–0.7)<0.001Nodal metastases Negative237116 (49%) Positive23643 (18%)2.5 (2.0–3.1)<0.0011.7 (1.3–2.2).<0.001Degree of differentiation G115772 (46%) G2 + G3 + G431687 (23%)1.8 (1.4–2.3)<0.0011.4 (1.1–1.8)0.016Lymphovascular invasion Negative17294 (55%) Positive30165 (22%)2.7 (2.1–3.4)<0.00115.(1.1–2.1)0.011Invasionperineural Negative240115 (48%) Positive23344 (19%)2.4 (1.9–3.0)<0.0011.2 (0.9–1.6)0.205Resection margin Negative419153 (37%) Positive546 (11%)2.8 (2.4–3.9)<0.0011.6 (1.1–1.3)0.007OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated. Open table in a new tab OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated.

Objective: To evaluate the results by comparing one-stage to multiple-stage surgery, as well as to define the causes that would allow to reduce the number of relaparotomies in one-stage surgeries in patients with acute pancreatitis with necrosis. Material and Method: From January 1999 to January 2005, ninety-two patients with necrosis were operated on in the Pancreatic Unit of the Rebagliati Hospital, in Lima Peru, where twenty-six patients underwent one stage surgery while sixty-eight required more than just one surgery. The severity of the cases and the percentage of necrosis exhibited were similar in both groups. Results: Twenty-six patients underwent one-stage necrosectomy while sixty-eight were operated on an average of four times. The average age was similar (p = 0.32) in both groups and the patients that had a one stage necrosectomy underwent surgery later (32 days) than those who were relaparotomized (22 days). When comparing medical and surgical complications, there was a considerable lower incidence of them among patients who underwent one stage necrosectomy than among those who were relaparotomized (p = 0.001 and p = 0.032) The hospital stay was shorter among the first group in comparison with the group that underwent relaparotomies. Fifty-six (56) vs. sixty-eight (68) days, respectively. The mortality rate was lower in the group that underwent just one surgery (15%) in comparison with the group where relaparotomies were performed (22%); nevertheless, the decrease in the rate was not significant. Conclusions: One-stage necrosectomy reduces medical and surgical complications, the length of the hospital stay and costs; nevertheless, it does not decrease the mortality rate in a significant way. The factors that allow us to define which patients could undergo one-stage surgery include delaying the surgery and surgical complications as much as possible, no matter the percentage of necrosis exhibited by each patient.

Summary: Solid pseudopapillary tumors are neoplasms of very low incidence that generally affect young females and have a slow growth pattern, reaching therefore a large size. The majority of them are tumors of low malignant potential. Material and Method: A research was carried out including the cases of the Massachusetts General Hospital (MGH) (1982 to 2006) and the Hospital Edgardo Rebagliati (HNERM) (1991 to 2006), and, in addition, an exhaustive review of worldwide literature was performed. The database included gender, localization, size, invasion and metastasis. Results: During the aforementioned period of time, thirty-one patients were operated on at the MGH and at the HNERM. 87% of these patients were females, being the average age 35.8 years and the average size 7.5 cm. In 57% of the cases the body and tail was the most frequent location. Three patients exhibited local invasion (15.1%) and just one developed hepatic metastasis. The literature was exhaustively reviewed and 630 cases were listed. 89.4% of these cases were females with an average age of 31.2. The average size was 8.2 cm and 57.3% of the neoplasms were located in the body and tail of the pancreas. Local invasion occurred in 11.8% of the cases and 5.9% of the patients presented metastasis. The size was inversely proportional to the age, being the tumors larger in patients under 30 years of age (10.3 cm vs. 7.8 cm) (p = 0.0001). The tumors were more aggressive (higher incidence of metastasis) in patients over 30 years of age (p = 0.042). The size-gender ratio was discovered to be higher among females, with an average of 9.46 cm. in female patients against 6.3 cm in males (p = 0.000). Discussion: Solid pseudopapillary tumors are generally uncommon neoplasms with a low malignancy potential and surgery remains the only therapeutic option. They exhibit a bizarre behavior since age is inversely proportional to their size. They are more aggressive in patients over 30 years of age and there is a predisposition among women, persisting the suspicion that these tumors are influenced by a hormonal stimulus.