A Case Report of Advanced Periampullary Carcinoma: Palliative Chemotherapy Following Whipple’s Surgery

Year : 2024 | Volume :13 | Issue : 01 | Page : 1-6
By

Zaid Khan

Ramya CV

Mekkanti Manasa Rekha

Abstract

This case report delves into the complex management of a 60-year-old female patient diagnosed with Stage 4 periampullary carcinoma, encompassing the pancreatic head. Presenting with difficulty in eating, diagnostic investigations, including ERCP, confirmed the diagnosis, leading to Whipple’s surgery. Postoperatively, liver metastasis was identified, prompting palliative intervention through stenting and the initiation of a GEMOX chemotherapy regimen. The patient responded favorably to the initial chemotherapy cycle, leading to a planned four-cycle course. Notable laboratory abnormalities included elevated liver enzymes. The multidisciplinary approach involved medical oncology, surgery, and supportive care teams, focusing on symptom amelioration and optimizing the patient’s overall quality of life. Despite generally low survival rates for periampullary carcinoma, the positive response to palliative chemotherapy was evident during follow-up, emphasizing the evolving nature of treatment strategies. This case underscores the imperative of expeditious diagnosis and tailored interventions, highlighting the crucial role of palliative chemotherapy in improving patient outcomes. Regular surveillance, symptom management, and comprehensive supportive care collectively contributed to an enhanced quality of life for the patient throughout the chemotherapy follow-up period. The report contributes to academic understanding, emphasizing the multidisciplinary approach’s significance in addressing the complexities of periampullary carcinoma management. Discussion highlights the significance of a multidisciplinary approach in addressing periampullary carcinoma complexities. The case underscores the need for expeditious diagnosis and tailored treatment strategies. Despite generally low overall survival rates for periampullary carcinoma, the positive response to palliative chemotherapy and its impact on the patient’s quality of life were evident during follow-up appointments. The report contributes to the academic understanding of periampullary carcinoma management, emphasizing the crucial role of palliative chemotherapy in enhancing patient outcomes

Keywords: Periampullary carcinoma, Whipple’s surgery, Palliative chemotherapy, Liver metastasis, Endoscopic Retrograde Cholangiopancreatography (ERCP).

[This article belongs to Research & Reviews: Journal of Oncology and Hematology(rrjooh)]

How to cite this article: Zaid Khan, Ramya CV, Mekkanti Manasa Rekha. A Case Report of Advanced Periampullary Carcinoma: Palliative Chemotherapy Following Whipple’s Surgery. Research & Reviews: Journal of Oncology and Hematology. 2024; 13(01):1-6.
How to cite this URL: Zaid Khan, Ramya CV, Mekkanti Manasa Rekha. A Case Report of Advanced Periampullary Carcinoma: Palliative Chemotherapy Following Whipple’s Surgery. Research & Reviews: Journal of Oncology and Hematology. 2024; 13(01):1-6. Available from: https://journals.stmjournals.com/rrjooh/article=2024/view=132433


References

  1. Fernandez-Cruz L. Periampullary carcinoma. InSurgical treatment: evidence-based and problem-oriented 2001. Zuckschwerdt.
  2. Bansal A, Dalal V, Kaur M, Siraj F. Periampullary carcinoma: unusual sites of metastasis. Ochsner Journal. 2017 Dec 21;17(4):426-9.
  3. Büchler M, Uhl W, Malfertheiner P. Diseases of the pancreas: acute pancreatitis, chronic pancreatitis, neoplasms of the pancreas. Karger Medical and Scientific Publishers; 2004.
  4. Takahashi Y, Fukusato T. Adenomyoma of the small intestine. World Journal of Gastrointestinal Pathophysiology. 2011 Dec 12;2(6):88.
  5. Büchler M, Uhl W, Malfertheiner P. Diseases of the pancreas: acute pancreatitis, chronic pancreatitis, neoplasms of the pancreas. Karger Medical and Scientific Publishers; 2004.
  6. Sheorain, Ashwini, A CLINICAL STUDY ON VARIOUS MODES OF PRESENTATION OF PANCREATOBILIARY MALIGNANCIES. “international journal of scientific research.” Volume – 10 | Issue – 07 | July – 2021; Pg 1-3.
  7. Winterling J, Lampic C, Wettergren L. Fex-Talk: A short educational intervention intended to enhance nurses’ readiness to discuss fertility and sexuality with cancer patients. Journal of Cancer Education. 2020 Jun;35:538-44.
  8. Zeng L, Gowda BJ, Ahmed MG, Abourehab MA, Chen ZS, Zhang C, Li J, Kesharwani P. Advancements in nanoparticle-based treatment approaches for skin cancer therapy. Molecular Cancer. 2023 Jan 12;22(1):10.
  9. Xia, Chenglai, et al. “CD39/CD73/A2AR pathway and cancer immunotherapy.” Molecular Cancer 22.1 (2023): 1-17.
  10. Pilard C, Ancion M, Delvenne P, Jerusalem G, Hubert P, Herfs M. Cancer immunotherapy: it’s time to better predict patients’ response. British Journal of Cancer. 2021 Sep 28;125(7):927-38.
  11. Xia, Chenglai, et al. “CD39/CD73/A2AR pathway and cancer immunotherapy.” Molecular Cancer 22.1 (2023): 1-17.
  12. Burati M, Terragni S, Scaini A, Bonfanti G, Chiarelli M, Guttadauro A, Zago M. Diagnosis and treatment of pancreatic incidentalomas. Ann. Ital. Chir. 2021;92(6):632-5.
  13. De Rooij T, Klompmaker S, Hilal MA, Kendrick ML, Busch OR, Besselink MG. Laparoscopic pancreatic surgery for benign and malignant disease. Nature reviews Gastroenterology & hepatology. 2016 Apr;13(4):227-38.
  14. Mori T, Abe N, Sugiyama M, Atomi Y. Laparoscopic hepatobiliary and pancreatic surgery: an overview. Journal of hepato-biliary-pancreatic surgery. 2002 Dec;9:710-22.
  15. Siebert, Werner E. “Overview of arthroscopic laser surgery in Europe.” Arthroscopic Laser Surgery: Clinical Applications. New York, NY: Springer New York, 2012. 175-178.
  16. Grace, P. A., H. A. Pitt, and W. P. Longmire. “Pylorus preserving pancreatoduodenectomy: an overview.” Journal of British Surgery 77.9 (1990): 968-974.
  17. Kumar PN, Lakshmi RM, Karthik GS. A clinical study on obstructive jaundice. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES-JEMDS. 2016 Dec 19;5(101):7444-.
  18. Rizzo A, Dadduzio V, Lombardi L, Ricci AD, Gadaleta-Caldarola G. Ampullary carcinoma: an overview of a rare entity and discussion of current and future therapeutic challenges. Current Oncology. 2021 Sep 1;28(5):3393-402.
  19. JIANG, L. “The problems and discussion on the controversy of preoperative biliary drainage in malignant obstructive jaundice.” Med Recapitulate 20.5 (2014): 806-809.
  20. Mizuno T, Ishizaki Y, Ogura K, Yoshimoto J, Kawasaki S. Clinical significance of immunohistochemically detectable lymph node metastasis in adenocarcinoma of the ampulla of Vater. Journal of British Surgery. 2006 Feb;93(2):221-5.
  21. de Jong, Evelien JM, et al. “Adjuvant and first-line palliative chemotherapy regimens in patients diagnosed with periampullary cancer: a short report from a nationwide registry.” Acta Oncologica 61.5 (2022): 591-596.
  22. Perone, Jennifer A., Taylor S. Riall, and Kelly Olino. “Palliative care for pancreatic and periampullary cancer.” Surgical Clinics 96.6 (2016): 1415-1430.
  23. de Jong, Evelien JM, et al. “Adjuvant and first-line palliative chemotherapy regimens in patients diagnosed with periampullary cancer: a short report from a nationwide registry.” Acta Oncologica 61.5 (2022): 591-596.
  24. Ponweera, Arachchige DNR, Paula Ghaneh, and John P. Neoptolemos. “Adjuvant and Palliative Chemotherapy of Periampullary Cancers.” The Pancreas: An Integrated Textbook of Basic Science, Medicine, and Surgery (2023): 1291-1298.

Regular Issue Subscription Review Article
Volume 13
Issue 01
Received January 19, 2024
Accepted January 25, 2024
Published February 5, 2024