Pancreatico-duodenectomy: 5-year experience

Abstract

Abstract Background: Pancreatico-duodenectomy is the only potentially curative treatment of pancreatic cancer and is considered one of the most technically demanding and challenging procedures. Survival after surgery of pancreatic cancer is still poor. Aim of the study: was to estimate the resectability rate of pancreatic and periampullary tumors presenting with jaundice and to assess the outcome of tumors treated by pancreatico­ duodenectomy. Patients and methods: Throughout a 5-year period from 2006 to 2011, 378 patients presented with tumors involving the head of pancreas or periampullary region. Pancreatico-duodenectomy was performed for 65 (17.2%) patients with resectable tumors. Follow up was done for 3 years. Univariate and multivariate analyses were done for factors affecting the postoperative survival. Results: Resectability was feasible in 17.2% of patients. After pancreatico-duodenectomy, complications occurred in 32.3% of patients. Pylorus preservation did not affect the rate of complications. The 1-, 2- and 3-year survival rates were 64.6%, 43.1% and 35.4% respectively. Survival more than 3 years was significantly related to tumor diameter up to 3cm,free resection margin, absence of lymph nodes involvement, well differentiation of the tumors and periampullary tumors. By multivariate regression analysis, tumor diameter not exceeding 3cm and absence of lymph nodes involvement were found to be the most predictive factors correlated to survival more than 3 years. Conclusion: The malignant pancreatic tumors have a low resectability rate. Most of pancreatic tumors present in late stages. Tumors not exceeding 3cm in diameter and absence of lymph nodes involvement were predictive of probable 3 year survival. Key words: Pancreatic carcinoma, jaundice, resectability, surgical outcome