Predictive Factors Associated with Survival in Periampullary Cancers Following Pancreaticoduodenectomy

Abstract

Introduction: Pancreaticoduodenectomy (PD) is the procedure of choice for periampullary cancers. Factors like lymphovascular invasion, perineural invasion have been identified as poor prognostic factors for survival after pancreaticoduodenectomy. We aimed to identify predictive factors associated with survival in periampullary cancers following pancreaticoduodenectomy. Methodology: We analysed prospectively maintained records of patients who underwent PD at Tribhuvan University Teaching Hospital, Kathmandu, from April 2004 to May 2014. Univariate analysis of various prognostic factors associated with survival was performed. Those factors identified to be significant in univariate analysis were included in the multivariate analysis, and was analysed using the Cox proportional hazard model. Statistical significance was considered when p-value was <0.05. The SPSS v16.0.1 software was used for statistical analysis. Results: The study included 61 patients. The median survival of all patients was 24 months. Median survival of patients having pancreatic carcinoma, ampullary carcinoma, distal cholangiocarcinoma and duodenal adenocarcinoma were 8, 24, 24 and 23 months respectively. Non-pancreatic periampullary cancer patients had better median survival as compared to pancreatic cancer patients (24 vs. 8 months, p = 0.03). The presence of Lymphovascular invasion (LVI), Perineural invasion (PNI), lymph node involvement, higher Lymph node ratio (LNR) and higher pathological stage were associated with poor median survival in univariate analysis. But multivariate analysis showed perineural invasion as the only factor associated with poor survival. Conclusion: Perineural invasion is associated with poor survival outcome in patients with periampullary cancers following pancreaticoduodenectomy.