الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Pancreatic carcinoma the fourth leading cause of cancer death in the United States. Material & Methods In this study 60 patients underwent pancreatico duodenectomy in gastroentrology surgical center Mansoura University. all patients had chosen from out patient in gastroentrology surgical center Mansoura University after laboratory, radiological & endoscopic investigations. for periampullary carcinoma, 36 (60%) pancreatic carcinoma, 15 (23%) ampullary carcinoma, 6 (10%) carcinoma of the lower third C.B.D., 3 (5%) duodenal carcinoma. 46 (76.7%) were subjected to pancreatico gastrostomy and 14 (23.3%) were subjected to pancreatico jejunostomy. In recent operative theater in gastroentrology surgical center Mansoura University All patients were followed in gastroentrology surgical center Mansoura University regularly for 6 years. (The period of follow up in out patient clinic in gastroentrology surgical center Mansoura University, for them endoscopy, radiology, laboratory investigations. Recurrence was detected in 45 (75%) of total population with 8 (13%) were in the form of liver metastases 26 (43.3%) local recurrence and 7 (11.7%) recurrence in lymph nodes. While local metastases and liver metastases in 4 (6.7%). Late mortality (6 years follow up) was occurred in 52 (88%) patients with recurrence related mortality was in 45 (86.5%), cardiac problems in 2 (3.8%) and 2 (3.8%) were of unknown cause. We conclude that first, surgery is the best line of management of periampullary cancers with acceptable rate of complications & hospital mortality & better quality of life after surgery provided that operation should be done at special center as gastroentrology surgical centre & done by specialized team of surgeons & assistant surgeons of pancreatic cancers also presence of intensive care unit and good anatheatic team. Second, there were different factors. Influencing survival as periampullary tumors less than 3cc in diameter & negative resection margin for tumor infiltration negative abdominal L.N for malignancy, well differentiated tumors & stage I & II of TNM staging were associated with significant increase in survival.