LAUSR

Periampullary cancer (PC) is a term encompassing malignancies that originate near the ampulla of Vater. It includes cancers of the head and neck of the pancreas, distal common bile duct, second part of the duodenum, and the ampulla itself. Differentiating between these entities, evenwith biopsy, is often not possible. Therefore, PC ismanaged identically to pancreatic adenocarcinoma, the fourth leading cause of cancer death in the United States despite representing only 3.1% of new cancer diagnoses [1]. Surgical resection by pancreaticoduodenectomy is the only potentially curative measure [2]. Unfortunately, as PC frequently presents at an advanced stage (particularly pancreatic adenocarcinoma), it is often inoperable at the time of diagnosis [3]. The 2016 National Comprehensive Cancer Network (NCCN) Guidelines for Pancreatic Adenocarcinoma define criteria to determine resectability [2]. Nonetheless, a subset of patients undergo noncurative laparotomy (NCL) either because the resection is 1) margin positive (termed an R1 resection) [4,5] or 2) the disease is found to be unresectable due to local invasion or unexpected metastases [6,7]. Although it is not the preferred outcome, NCL can benefit patients via definitive staging in borderline resectable cases, surgical bypass of obstructed bowel or bile ducts, placement of fiducial markers for radiation therapy, and tumour debulking.