Survival after pancreaticoduodenectomy for periampullary adenocarcinoma: an update

Geenen, Rutger C. I. van; Gulik, Thomas M. van; Offerhaus, G.J.A.; Wit, L. T. de; Busch, O.; Obertop, H.; Gouma, Dirk J.

doi:10.1053/ejso.2001.1162

Cited by 71 publications

(82 citation statements)

References 42 publications

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“…On multivariate investigation, lymph node negative, R0 surgical margin and well/moderate tumour differentiation appear to be independent factors to predict improved survival in periampullary and pancreatic carcinomas. These results are in accordance with previous reports in the literature [8, 9, 11, 16]. A separate multivariate model was done for adenocarcinomas of the head of the pancreas, which showed that cellular differentiation and the tumour compromise of the portal vein were the only independent factors to predict survival.…”

Section: Discussionsupporting

confidence: 91%

“…In a more recent study, specialization also appears to improve survival [15]. In our series, 251 patients underwent pancreatic resection with outcome comparable with the literature, where the established mortality after Whipple’s resection varies between 2 and 28% [4, 8, 9, 12, 16]. Our 4.8% operative mortality is consistent with other centres with reasonable surgical experience.…”

Section: Discussionsupporting

confidence: 88%

“…Despite the fact that nowadays there are several accurate diagnostic tests in pancreatic cancer such as CT scan, MRI, endoscopic ultrasonography, it is well known that the majority of patients with pancreatic cancer do not undergo curative surgical resection due to a usually late stage detection of their illness and therefore, actuarial survival has not changed [8, 9, 10, 11]. This suggests that the disease remains asymptomatic for a long period and therefore, diagnosing pancreatic tumours at an early stage is unlikely.…”

Section: Discussionmentioning

confidence: 99%

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Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

et al. 2004

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Aims: To present the surgical experience in a regional unit, analysing the post-operative outcome, and determining risk factors for survival after pancreaticoduodenectomy for periampullary and pancreatic head carcinoma. Methods: Data were collected on 251 patients with pancreatic head adenocarcinoma (133), ampullary carcinomas (88) and distal common bile duct (30), between 1987 and 2002. Survival was calculated using the Kaplan-Meier method. Clinical, surgical and histopathological records were examined by univariate and multivariate analysis to identify the independent prognostic predictors of survival. Results: Median actuarial survival for carcinoma of the pancreatic head, ampulla and distal bile duct were 13.4, 35.5 and 16 months, respectively; p < 0.0001. On univariate analysis for the whole series, the age ≤60, tumour of the head of the pancreas, lymph node positive, resection margin R1, poorly differentiated tumours, and portal vein invasion significantly decreased survival. On multivariate analysis, poor tumour differentiation, surgical margin, lymph node metastases, and age independently influence survival. Mortality and morbidity were 4.8 and 29.9%, respectively. Conclusions: Pancreaticoduodenectomy for pancreatic and periampullary tumours is the only therapy that may cure patients and can be performed safely in centres with significant experience.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

et al. 2004

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“…In 2000, both the median postoperative stay declined over time to 8 days and perioperative mortality decreased to 1% [4]. Median survival after resection for carcinoma of the ampulla of Vater is 24 months with 43% 5-year survival [5].…”

Section: Introductionmentioning

confidence: 99%

Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: and review of the literature

Skórzewska¹,

Polkowski²

2011

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Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) should have stenting of the biliary system to prevent cholangitis. However, the most serious complication of ERCP is pancreatitis. There are only scattered data on the impact of post-ERCP pancreatitis on the surgical management of periampullary tumours. We report the case of a patient with carcinoma of the ampulla of Vater who underwent preoperative biliary stenting complicated with severe acute pancreatitis and was effectively treated by pylorus preserving pancreaticoduodenectomy (PD) 3 months later. In the postoperative course, grade A pancreatic fistula was observed, with no substantial prolongation of hospital stay. Pathological findings revealed stage II ampullary carcinoma with multiple foci of pancreatic necrosis. Three weeks after the procedure, the patient fully recovered, and started adjuvant chemotherapy. Disease free survival DFS was 27 months and OS 44 months. Pancreaticoduodenectomy can be performed after severe acute necrotizing pancreatitis caused by preoperative biliary stenting, provided adequate timing of surgery is ensured, albeit with the risk of postoperative complications. Even severe post-ERCP pancreatitis should not be regarded as a contraindication for curative PD, especially in patients with periampullary adenocarcinoma, since long-term survival can be achieved. StreszczeniePacjenci poddawani endoskopowej cholangiopankreatografii wstecznej (ECPW) powinni mieć wykonywane protezowanie dróg żółciowych, aby zapobiec zapaleniu dróg żółciowych. Najpoważniejszym jednak powikłaniem po ECPW jest zapalenie trzustki. Dane z piśmiennictwa na temat wpływu zapalenia trzustki po ECPW na postępowanie chirurgiczne u chorych na raka brodawki Vatera są niepełne. Autorzy przedstawiają chorą na raka brodawki Vatera, u której powikłaniem przedoperacyjnego protezowania dróg żółciowych było ciężkie, ostre zapalenie trzustki, które skutecznie leczono wykonaną 3 miesiące później pankreatoduodenektomią (PD) z zachowaniem odźwiernika. W przebiegu pooperacyjnym zaobserwowano wystąpienie przetoki trzustkowej (w stopniu A), bez wpływu na czas hospitalizacji. Wynik badania histopatologicznego potwierdził rozpoznanie raka brodawki Vatera w stadium II z licznymi ogniskami martwicy w obrębie trzustki. Trzy tygodnie po zabiegu pacjentka zakończyła rekonwalescencję pooperacyjną i rozpoczęła chemio terapię uzupełniającą. Przeżycie wolne od objawów choroby wyniosło 27 miesięcy, a przeżycie całkowite 44 miesiące. Pankreatoduodenektomia może być wykonana po ciężkim, ostrym zapaleniu trzustki spowodowanym endoskopowym protezowaniem dróg żółciowych, pod warunkiem podjęcia decyzji o operacji w odpowiednim czasie, z uwzględnieniem ryzyka wystąpie-nia powikłań pooperacyjnych. Nawet ciężkie zapalenie trzustki po ERCP nie powinno być traktowane jako przeciwwskazanie do PD z zamiarem wyleczenia, zwłaszcza u chorych na gruczolakoraka brodawki Vatera, ponieważ stwarza nadzieję na dobry wynik odległy.

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“…Intraabdominal recurrence ranged 38% to 86% [1][2][3] . Factors influencing recurrence in some studies included lymph node metastasis [4,5] , tumor size [5,6] , and tumor in surgical resection [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Risk factors influencing recurrence following resection of pancreatic head cancer

Mu¹,

Peng²,

Wang³

2004

WJG

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AIM:Whether operative procedure is a risk factor influencing recurrence following resection of carcinoma in the head of pancreas or not remains controversies. In this text we compared the recurrence rate of two operative procedure: the Whipple procedure and extended radical operation, and inquired into the factors influencing recurrence after radical resection. METHODS:From January 1995 to December 1998, 35 cases of carcinoma of pancreas underwent the Whipple operadure, 21 patients received the Extended radical operation. All patients were followed up for more than 3 years. Prognostic factors included operative procedure, size of tumor, lymph node, interstitial invasion. RESULTS:Deaths duo to recurrence within 3 years after operation were studied. The death rate was 51.4% in the Whipple procedure and 42.9% in the Extended radical operative procedure. There was a significant difference between the two groups. Recurrence occurred in 75% patients with tumor large than 4 cm, in 87.5% patients with lymph node involvement, and in 50% patients with the presence of interstitial invasion. CONCLUSION:Tumor exceeding 4 cm, lymph node involvement, and presence of interstitial invasion are high risk factors of recurrence after Whipple's procedure and extended radical operation.Mu DQ, Peng SY, Wang GF. Risk factors influencing recurrence following resection of pancreatic head cancer. World J Gastroenterol 2004; 10(6): 906-909

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Survival after pancreaticoduodenectomy for periampullary adenocarcinoma: an update

Cited by 71 publications

References 42 publications

Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: and review of the literature

Risk factors influencing recurrence following resection of pancreatic head cancer

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