WTP3.1 Histological stage and five-year recurrence/survival in patients who undergo pancreatoduodenectomy for ampullary adenocarcinoma

Abstract

Abstract Aims Patients with ampullary adenocarcinoma (AA) may be offered pancreatoduodenectomy (PD) with curative-intent providing they are appropriate surgical candidates. This study aimed to investigate and quantify the relationship between histological T and N stage, and five-year recurrence/survival in this group. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, n=1484). Patients with AA were grouped by their T stage and N stage, and five-year recurrence/survival rates were compared using Fisher’s exact test. Results 394 patients (27%) had AA. T1, T2, T3 and T4 disease affected 46 (12%), 131 (33%), 130 (33%), and 86 (22%) patients, respectively (Tx: 1). Five-year recurrence was 11%, 35%, 53% and 65%, respectively. Patients with T3-4 disease (vs T1-2) had significantly higher rates of five-year recurrence (OR: 3.4, 95% CI: 2.2-5.2). Five-year survival was 78%, 65%, 45% and 36% in patients with T1, T2, T3 and T4 disease, respectively. Patients with T1-2 disease (vs T3-4) had significantly higher rates of five-year survival (OR: 3.1, 95% CI: 2.0-4.7). Concerning nodal status, 154 patients (39%) had no lymph node involvement and 239 (61%) had positive regional lymph nodes (could not be assessed in one patient). Patients with N0 disease (vs N1) had lower five-year recurrence (OR: 0.3, 95% CI: 0.2-0.4) and higher five-year survival (OR: 4.5, 95% CI: 2.7-6.6) rates. Conclusion In our multicentre study of AA patients who underwent PD, increasing T and N histological stages were found to correlate with increased five-year recurrence and reduced five-year survival rates.