How to Deal with a Periampullary Mass?

Facing with a periampullary mass, the first step is to reach a diagnosis, if possible, before surgery. The second step in the case of malignancy is the accurate staging and then deciding whether it is resectable or not. Even if obtaining iniformation about the characteristics of the disease (nature, size, exact location) and establishing the tissue diagnosis preoperatively may semplify the decision to operate and the operation itself (saving both time, human and economic costs), nowadays pancreatoduodenectomy has less then 5 percent mortality rate in experienced centers. As a consequence, surgeons in high volume centre are more willing to embark on resecting a periampullary mass without a tissue diagnosis and an extensive work-up. Diagnosis then seems to be less important than appropriate staging [1]. In this paper we discuss the limitation of the diagnostic methods in periampullary lesions suggesting the way to follow on the basis of actual acknowledgements.