Appraisal of arteriography for assessment of operability in periampullary cancer.

The preoperative arteriograms in 87 periampullary cancers were analyzed in relation to the extension of tumor as explored in surgery, the resectability and the survival time. Most of the patients in whom the pancreaticoduodenal arcades were intact (Group I-O) showed no extension of the lesion into the surroundings and survived more than two years after pancreatoduodenectomy. Those in which the invasion was confined to the anterior pancreaticoduodenal arcade (Group I-A) could also be resected with much anticipation of long survival. About a third of the patients, in whom either the posterior arcade (Group I-P) or both anterior and posterior arcades were invaded (Group I-AP), were resectable. Only a few patients with the involved gastroduodenal artery (Group 2-A) or with the involved superior mesenteric artery (Group 2-P) were treated by extended pancreatoduodenectomy, but they died of recurrence shortly after resection. Further extension of the lesion was explored in surgery when preoperative angiography showed invasion of both the gastroduodenal and superior mesenteric arteries (Group 2-AP) or of the extrapancreatic vessels such as the hepatic artery (Group 3-C), intestinal arteries (Group 3-M) and both (Group 3-CM). Survival in these cases was only a few months after by-pass operation.