Abstract
366 Background: There is scarcity of short and long term data regarding results of pancreaticoduodenectomy done for periampullary tumours. Contrary to the western data, ampulla of Vater is the commonest site of involvement in Indian patients. Methods: A retrospective analysis PD was done for periampullary tumors from 1991 to July 2013 at TMC. The time period was divided into 4 spans A (1991 to 2001), B (2003 to July 2009), C (Aug 2009 to Dec 2012) and D (Jan 2013 to July 2013) based on the increasing surgical volumes and changing practice trends. Survival outcomes were analysed. Data was prospectively maintained from 2006 onwards. Results: 626 pts underwent PD for periampullary tumors over this time period. 144, 206, 150 and 126 pts were operated during span A, B, C and D respectively. Sites involved were ampulla (67.5%), head of pancreas (16.6%), duodenum (9.9%) and bile duct (6.9%). Adenocarcinoma was the most common histology (81.5%). The morbidity and mortality was 31.7% and 4.3%. Postoperative pancreatic fistula, delayed gastric emptying (DGE), post-pancreatectomy haemorrhage (PPH) and bile leaks were 12.4%, 2.8%, 4.8% and 2.7% respectively for the whole group. Morbidity, mortality, DGE, PPH and bile leak rates have declined over subsequent time periods. Majority of pts in span C and D received adjuvant chemotherapy with gemcitabine 1000mg/m2 on day 1,8 and 15 of a 28 day cycle. 2 year disease free survival (DFS) for periampullary adenocarcinoma-ampulla, bile duct & pancreas from April 2006 for 294 pts was 79.3%, 68.6% and 41.8% respectively. Overall 2 year DFS was 74%. Conclusions: These data represent the largest single centre experience with PD from Indian subcontinent. The improvement of results over the 2 decades can be due to increasing volume of pts, standardisation of surgical technique and gradually increasing experience of the operating team. The impressive 2 year DFS can be attributed to a large number of good prognosis ampullary tumors.
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