Pancreatoduodenectomy for pancreatic head and periampullary adenocarcinomas: outcomes and predictive factors for long term survival

Abstract

Background: Pancreatoduodenectomy (PD) is the only curative treatment for resectable tumors of the head of the pancreas and periampullary regions. The aim of this study was to evaluate the outcomes and identify the predictive factors influencing long term survival of these patients at our center. Methods: Retrospective analysis of prospectively maintained database of PD patients between 2010-15, at our institute was performed. Results: Out of 102 patients, 81 patients with mean age of 52 years were analysed(8 expired and 13 lost to follow up). The incidence of postoperative complications was 36%. The overall survival was 66.5% at 1 year and 17.5% at 5 years, with a median survival of 33 months. On histopathology, 40% of patients had T3/T4 disease, 37% had lymph node involvement, 20% had poorly differentiated histology, and 9% had positive resection margins. Predictive factors for long-term survival in both univariate analysis and multivariate analysis included absence of preoperative biliary drainage, low baseline CA 19-9 level, R0 resection, tumor diameter (size <3 cm) and grade, absence of lymph node involvement or distant metastasis, lymphovascular and perineural infiltration and adjuvant chemotherapy. Conclusion: Thus completeness of resection, tumor characteristics including tumor diameter and degree of differentiation, and adjuvant chemotherapy are important independent prognostic factors for survival. Preoperative biliary drainage and high baseline CA 19-9 levels had negative impact on long term survival.