Long-term outcomes of periampullary adenocarcinomas after pancreaticoduodenectomy – a peruvian multi-institutional study

Abstract

Background: Reports of periampullary adenocarcinomas are scarce in Latin-America. Pancreatic adenocarcinoma (PA) has the highest incidence in western countries, but also worse survival compared to distal bile duct (DBD), ampullary (AA) and duodenal (DA) adenocarcinomas, even after being resected by pancreaticoduodenectomy (PD). In this study, we analyze the survival of patients with resected periampullary adenocarcinomas and determined factors that influence this outcome. Methods: We retrospectively analyzed patients undergoing PD for periampullary adenocarcinoma from 2002 to 2011 in the three major pancreatic surgery centers in Peru. Postoperative mortalities (90-day) were excluded. Clinicopathologic features that may influence overall survival (OS) were collected and analyzed by Kaplan–Meier method. Log-Rank test and Cox regression modelling were used for univariate and multivariate analysis, respectively. Results: 473 Periampullary adenocarcinomas (153 PA, 258 AA, 33 DBD and 29 DA) treated by PD were identified. 5-year OS was 34% with a median survival of 28 months for the entire cohort. PA was associated with the worst 5-year OS (11%) compared to DBD (24%), DA (41%) and AA (47%), respectively (p < 0.01). Predictors of poor survival were site of primary, age ≥ 70 years, tumor size ≥ 2.5 cm, high-grade tumors, nodal metastases, lymphovascular invasion, perineural invasion and positive resection margin. On multivariate analysis, site of primary and nodal metastases were the strongest predictors of survival. Conclusion: We report the oncologic outcomes of the largest multi-institutional series of resected periampullary adenocarcinomas in Peru and Latin-America. AA is the most frequently resected tumor and portent the best prognosis, while PA has the worst OS. Patient selection could account for differences with reports of developed countries.Table 1Univariate and multivariate analysis of predictors of OS in patients undergoing PD for periampullary adenocarcinomasVariableNumber of patients5 years OSUnivariate analysisMultivariate analysisHazzard ratio (95% CI)PHazzard ratio (95% CI)PSex Man21780(37%) Woman25679 (31%)1.1 (0.9–1.4)0.304––Age <70 years332118 (36%) ≥70 years14141 (29%)1.3 (1.1–1.7)0.0171.4 (1.1–1.8)0.008Tumor size <2.5 cm14676 (41%) ≥2.5 cm28783 (29%)1.5 (1.2–1.9)0.0011.1 (0.8–1.4)0.549Site of primary Pancreas15317 (11%)ReferenceReference Distal Bile Duct333 (24%)0.6(0.4–0.9)<0.0010.7 (0.4–1.0)0.008 Duodenum2912 (41%)0.3 (0.2–0.6)0.0080.6 (0.3–0.9)0.036 Ampulla of Vater258122 (47%)0.3 (0.2–0.4)<0.0010.5 (0.4–0.7)<0.001Nodal metastases Negative237116 (49%) Positive23643 (18%)2.5 (2.0–3.1)<0.0011.7 (1.3–2.2).<0.001Degree of differentiation G115772 (46%) G2 + G3 + G431687 (23%)1.8 (1.4–2.3)<0.0011.4 (1.1–1.8)0.016Lymphovascular invasion Negative17294 (55%) Positive30165 (22%)2.7 (2.1–3.4)<0.00115.(1.1–2.1)0.011Invasionperineural Negative240115 (48%) Positive23344 (19%)2.4 (1.9–3.0)<0.0011.2 (0.9–1.6)0.205Resection margin Negative419153 (37%) Positive546 (11%)2.8 (2.4–3.9)<0.0011.6 (1.1–1.3)0.007OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated. Open table in a new tab OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated.