Prognostic factors for long-term survival after pancreaticoduodenectomy for periampullary adenocarcinoma. A retrospective cohort study

Abstract

Background Periampullary adenocarcinoma (PAAC) had a poor prognosis, and pancreaticoduodenectomy (PD) remains the only potentially curative treatment. The study aimed to identify the impact of different clinicopathological factors on long-term survival following PD for PAAC. Patients and methods This study is a retrospective cohort study for the patients who underwent PD for pathologically proven PAAC from January 2010 to January 2019. Statistical analysis was done using Cox regression multivariate analyses for independent risk factors for survival. Result There were 137 patients with PAAC who underwent PD, 79 patients (57.7%) underwent pylorus-preserving PD. Pancreatico-jejunostomy was done in 108 patients (78.8%). The primary analysis showed that risk factors for poor long-term survival include patients with co-morbidities like hypertension or ischemic heart disease, Carbohydrate Antigen 19-9 > 400U/ml, tumor size > 3 cm, poor tumor differentiation, positive lymph nodes invasion, lymphovascular invasion, and Perineural invasion. Multivariate analysis demonstrated that large tumor size > 3 cm (HR: 0.177, 95%CI: 0.084–0.374, P = 0.002), poorly differentiated tumor (HR: 0.059, 95%CI: 0.020–0.0174, P = 0.016), and perineural invasion in the pathological study (HR: 0.101, 95%CI: 0.046–0.224, P = 0.006) were independent risk factors for poor 5-years survival. The prognosis was better in ampullary adenocarcinoma (5-year survival was 42.1%) than pancreatic adenocarcinoma (5-year survival was 24.3%). The 1, 3, 5 and 7-year overall survival rates were 84.5%, 57.4%, 35.9% and 20.1% respectively. Conclusion It seems from the current study that Tumor size > 3 cm, poor tumor differentiation, and Perineural invasion were independent predictors of poor survival in patients with PAAC.

A CT-Based Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Periampullary Carcinomas

“…Periampullary carcinomas (PCs) arise within 2 cm of the major duodenal papilla, including a heterogeneous group of malignant tumors originating from the pancreas, distal common bile duct (CBD), duodenum, and ampulla of Vater. Although rare, accounting for roughly 0.2% of gastrointestinal tumors ( 1 – 3 ), PC is one of the top five leading causes of cancer-related death worldwide ( 4 , 5 ), and the detection rate has substantially increased in the past few years ( 6 ). Traditionally, the treatment protocol is curative pancreaticoduodenectomy for resectable PCs, but the prognosis is still poor, with 5-year survival rates ranging from 6.5 to 32.8% after surgery ( 7 ).…”

Whole-volume apparent diffusion coefficient histogram analysis for prediction of regional lymph node metastasis in periampullary carcinomas

“…These tumors arise within 2 cm of the major duodenal papilla, and share a common embryologic origin from the foregut [1]. Although rare, accounting for roughly 0.2% of gastrointestinal tumors [2][3][4], PC is one of the top ve leading causes of cancer-related death worldwide [5], with the detection rate increasing year by year [6]. Pancreaticoduodenectomy remains the only potential curative option for resectable PCs, however, when rst diagnosed, nearly 70%-80% of the patients have lost the opportunity for surgery because of lymph node metastasis (LNM), adherent tissues or vessels invasion, and distant metastasis [7].…”

Differential diagnostic value of periampullary mass: A nomogram established by random forest based on clinical characteristics and contrast‐enhanced ultrasound

“…According to different histological subtypes, ampullary carcinoma can be divided into intestinal, pancreaticobiliary, and mixed types 1 . If the tumor is larger than 3 cm, with poor differentiation and peripheral nerve invasion, the 5‐year survival rate is only about 24%–42% 2,3 . Since the particularity of periampullary anatomical structure and the different subtypes of lesions have different treatments and prognoses, 4 an accurate location and qualitative diagnosis identification are essential for periampullary lesions in the early stage.…”