الفهرس 
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Abstract
This prospective study was designed to evaluate pancreaticoduodenectomy operation for periampullary tumors’ patients as regard mortality, morbidity. We evaluate overall survival and asses factors influencing survival and recurrence .This study included 80 patients with periampullary tumors. Those patients underwent pancreaticoduodenectomy in Gastro Enterology Center, Mansoura University. The mean age was 52 (±10.5) years. Male (58.7%), female (41.3%) Pancreatic tumors represented (53.7%), ampullary tumors (23.75%), duodenum tumors (6.25%) and distal CBD tumor (12.5%). Pancreaticogastrostomy was subjected in sixty six patients (82.5%) while, pancreaticojejunostomy in fourteen patients (17.5%). The mean operative time was 4.9 (±1.9) hours. Hospital mortality was occurred in two patients (2.5%). Postoperative complications pancreatic fistula (11.2%), delayed gastric emptying (7.5%), bile leak (2.5%), postoperative hemorrhage (6.2%), abdominal infection (3.7%), wound infection (13.7%)and pancreatitis (2.5%). Recurrence was detected in fifty one patients (63.7%). Factors affecting development of postoperative complications include age, diabetes, type of pancreatico-enteric anastomosis, preoperative biliary drainage and massive intra operative blood transfusion. Factors influence survival were site of the tumor ,size of the tumor, lymph nodes and resection margin for tumor infiltration, degree of differentiation ,level of tumor markers (CEA,CA19-9) and preoperative plattelets’count. The overall actuarial 1-,2- and 3- year survival rates were 89%,51%,29% and 5 -year survival rate was 19% with median survival was 27 months in our study.