Predictors of Survival in Periampullary Cancers Following Pancreaticoduodenectomy

Abstract

Background-Cancers of the ampulla of Vater, distal common bile duct, and pancreas are known to have dismal prognosis. It is often reported that ampullary cancers are less aggressive relative to the other periampullary carcinomas. We sought to evaluate predictors of survival for periampullary cancers following pancreaticoduodenectomy to identify biologic behavior.

Prediction of survival following percutaneous biliary drainage for malignant biliary obstruction

“…[10,21] Percutaneous biliary drainage is a method for palliative treatment considered in these patients, which relieves the high serum bilirubin related symptoms and provides them with an opportunity to receive additional therapies. However, PTBD is an invasive procedure and has its own risks and complications.…”

A 56-year-old woman with ampullary adenocarcinoma and acute pancreatitis

“…1 Albagi et al retrospectively compared the survival rates of 29 patients submitted to standard lymphadenectomy with 21 patients who underwent radical lymphadenectomy associated with classic gastropancreaticoduodenectomies to treat ampullary adenocarcinomas 7 . Postoperative mortality and morbidity are lower if the tumor is treated at an earlier stage 8 , but more extensive lymphadenectomy showed no statistically significant effect on the survival of the patients 7 . Hatzaras et al reviewed predictors of survival after pancreaticoduodenectomy for periampullary cancers, including preoperative jaundice, microscopic positive margin, lymph node metastasis, lymph vascular, blood vessel, or neural invasion, and grade of differentiation of the tumors 8 .…”

“…Postoperative mortality and morbidity are lower if the tumor is treated at an earlier stage 8 , but more extensive lymphadenectomy showed no statistically significant effect on the survival of the patients 7 . Hatzaras et al reviewed predictors of survival after pancreaticoduodenectomy for periampullary cancers, including preoperative jaundice, microscopic positive margin, lymph node metastasis, lymph vascular, blood vessel, or neural invasion, and grade of differentiation of the tumors 8 . From the 346 periampullary malignancies, 79 (22.8%) were ampullary carcinomas.…”

“…Nevertheless, the renal function of our patient was normal, and her acute pancreatitis was associated with an ampullary adenocarcinoma. She underwent a pancreaticoduodenectomy, which is the first choice of treatment 2,3,7,8 . After surgical procedure, the drug used to control her diabetes was changed from metformin to insulin, medicine that has been related to decrease in the risk of acute pancreatitis 5 .…”

“…Those authors concluded that neural invasion and nodal metastasis, in addition to the tumor biological behavior, represent the main predictive factors of poor outcomes in this setting. Moreover, infections (68/145: 19%) and fistulas (26/145: 7.6%) constituted the two major complications 8 .…”