Longterm survival after pancreaticoduodenectomy for periampullary adenocarcinomas

Abstract

Objectives: The aim of this study was to identify predictors for longterm survival following pancreaticoduodenectomy (PD) for pancreatic and other periampullary adenocarcinomas.

Methods: Clinicopathological factors were compared between short-term (<5 years) and longterm (≥ 5 years) survival groups. Rates of actual 5-year and actuarial 10-year survival were determined.

Results: There were 109 (21.8%) longterm survivors among a sample of 501 patients. Patients with ampullary adenocarcinoma represented 76.1% of the longterm survivors. Favourable factors for longterm survival included female gender, lack of jaundice, lower blood loss, classical PD, absence of postoperative bleeding or intra-abdominal abscess, non-pancreatic primary cancer, earlier tumour stage, smaller tumour size (≤ 2 cm), curative resection, negative lymph node involvement, well-differentiated tumours, and absence of perineural invasion. Independent factors associated with longterm survival were diagnosis of primary tumour, jaundice, intra-abdominal abscess, tumour stage, tumour size, radicality, lymph node status and cell differentiation. The prognosis was best for ampullary adenocarcinoma, for which the rate of actual 5-year survival was 32.8%, and poorest for pancreatic head adenocarcinoma, for which actual 5-year survival was only 6.5%.

Conclusions: The majority of longterm survivors after PD for periampullary adenocarcinomas are patients with ampullary adenocarcinoma. The longterm prognosis in pancreatic head adenocarcinoma remains dismal.

Figure 1

Actuarial survival following pancreaticoduodenectomy for periampullary adenocarcinomas in patients with (1) pancreatic head adenocarcinoma (n = 169), (2) ampullary adenocarcinoma (n = 253), (3) distal common bile duct (CBD) adenocarcinoma (n = 52) and (4) duodenal adenocarcinoma (n = 27). Subgroup comparisons showed: (1) versus (2), P = 0.000; (1) versus (3), P = 0.001; (1) versus (4), P = 0.028; (2) versus (3), P = 0.352; (2) versus (4), P = 0.202, and (3) versus (4), P = 0.779