20 Predictors of Five-Year Recurrence and Five-Year Survival After Pancreatoduodenectomy for Ampullary Adenocarcinoma: An International Multicentre Cohort Study

Abstract

Abstract Aim Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable ampullary adenocarcinoma (AA). We aimed to identify predictors of five-year recurrence and five-year survival using a large multicentre cohort. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective study of PD outcomes (29 centres from 8 countries). Patients with AA who developed recurrence or died within five-years of PD were compared to those who did not experience these outcomes. Results A total of 394 patients had AA and five-year recurrence and five-year survival rates were 44.7% and 53.6%, respectively. The number of resected nodes, histological T stage I-II, lymphatic invasion, perineural invasion (PNI), peripancreatic fat invasion (PPFI) and ≥1 positive resection margin all had a significant association with both studied outcomes. The following correlated with reduced time-to-recurrence: ≥1 positive margin (median difference (MD): 144 days, p = 0.005), PPFI (MD: 214 days, p = 0.004) and PNI (MD; 124 days, p = 0.006). The following were predictors of reduced time-to-death: preoperative biliary stenting (MD: 119 days, p = 0.004), histological T stage >II (MD: 228 days, p<0.0001), histological N stage >0 (MD: 196 days, p = 0.004), PPFI (MD: 287 days, p = 0.007) and PNI (MD: 241 days, p<0.0001). Conclusions In our multicentre study of patients who underwent PD for confirmed AA, multiple predictors of five-year recurrence and five-year survival were identified. This information can guide postoperative management as those who are more likley to develop recurrence should arguably undergo earlier and more regular surveilance. In addition, ajuvant treatment is arguably more pertinent in this group.