Periampulatory carcinoma (Whipple’s procedure)

Jeya Karunya,

Staff Nurse, Kauvery Hospital, Tirunelveli

Abstract

Ampullary cancers are rare, accounting for only 0.2% of gastrointestinal cancers and approximately 7% of all periampullary cancers.They arise from the ampullary complex, distal to the confluence of the common bile and pancreatic duct. In contrast to other periampullary malignancies, true ampullary cancers present earlier in their disease course with symptoms that result from biliary obstruction. It is often difficult to distinguish primary ampullary cancers from other periampullary cancers preoperatively. In early stages, ampullary cancers are surgically treated, similar to pancreatic cancers, and typically with a pancreatico-duodenoectomy (or Whipple procedure). Because of their earlier presentation, resection rates for all patients are much higher than other periampullary carcinomas. Moreover, their prognosis tends to be better than those with other periampullary and pancreatic-originating cancers. In patients with true ampullary cancer, there is very limited data to guide physicians on the choice of therapy, largely because of the rarity of the disease and the paucity of related research. Herein, we provide an overview of the biology, histology, current therapeutic strategies, and potential future therapies for carcinomas arising from the ampulla of Vater.

Background

The patient was a 56 years old male. he came with complaints of stomach pain, heaviness in the stomach, loss of appetite and discomfort. After history collection, physical examination and investigation the doctor diagnosed as a periampullatory carcinoma. Then, the doctor planned to do pancreatioduodenectomy with whipple surgery.

Examination

CVS: S1, S2 is normal

RR: Bilateral mild pleural effusion

P/A: Soft

CNS: NFND

TEMP: 100.1F

SpO2: 99%

Bp: 140\80mmhg

HR: 144 beats\mts

RR: 44 breath\mts.

Investigations

CT Scan and ERCP-Accurately shows the periampullatory carcinoma.

Surgery Notes

Pancreatioduodenectomy or whipple procedure was done under general anesthesia. This procedure is done for doing correction in the pancreas, small intestine and bile ducts. It involves removing the first part of the small intestine, gall bladder and the bile duct.

Treatment

Inj. Piptaz-4.5 mg

Inj. Pantocid-40 mg

Inj. Paraglass-1 gm

Inj. Tramadol-50 mg

Inj. Octoeotide-100mg

Neb. Duoline and Budecort.

Nursing management

Educate on the different cancer treatment modalities.
Treatment options for patients with pancreatic cancer depend on the type, stage, and other aspects of cancer:
Neoadjuvant treatment(chemotherapy and/or radiation) prior to surgery is preferred for locally advanced unrespectable pancreatic cancer.
Adjuvant therapyincludes treating patients with resected pancreatic cancer with FOLFIRINOX (FOL = Leucovorin Calcium (Folinic Acid); F = Fluorouracil; IRIN = Irinotecan Hydrochloride; OX = Oxaliplatin) chemotherapy regimen.
Control the tumor growth
Radiation treatment can be coupled with chemotherapy (chemoradiation). Typically, chemotherapy treats cancer that has not metastasized (spread) to other organs from the pancreas. Chemotherapy may control tumor growth, ease symptoms, and extend survival in patients with advanced pancreatic cancer and metastasis.
Monitor the weight regularly.
Determine the presence of malnutrition.
Try an appetite stimulant.
Provide Emotional Support

Diet advice

During post-operative periods, initiate the liquid diet. After that, semi solid, solid diet and normal diet was given to the patient. Patient was tolerated. After that, advised to take normal diet as well as the balanced diet.

Outcome

On Discharge, patient was hemodynamically stable.

Ms. Jeya Karunya

Staff Nurse

Periampulatory carcinoma (Whipple’s procedure)