Outcome and prognostic factors for periampullary carcinoma after pancreaticoduodenectomy: A single tertiary center experience

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND| 2020. Objective: Pancreaticoduodenectomy (PD) remains the standard treatment in achieving long-term outcome for periampullary carcinoma. This study aims to evaluate outcome and prognostic factors of PD in a large tertiary center in Thailand. Materials and Methods: This study is a single-center, retrospective study including patients who underwent PD for periampullary carcinoma at Siriraj Hospital from 2011 to 2015. Univariate and multivariate analyses were performed to identify poor clinicopathological prognostic factors for survival after PD. Results: A total of 128 patients who underwent PD for periampullary carcinoma at Siriraj Hospital between 2011 and 2015 were included. Five-year overall survival was 16% with median survival time of 23 months. Patients with ampullary cancer (25.7%) and duodenal cancer (21.1%) had longer 5-year survival than pancreatic cancer (13.3%) and distal cholangiocarcinoma (0%) (p<0.001). Multivariate analysis showed that independent adverse prognostic factors were perineural invasion (HR: 3.94, 95% CI: 1.90 to 6.40, p<0.01), N2 nodal status (HR: 2.98, 95% CI: 1.16 to 7.64, p = 0.02), positive resection margin (HR: 1.93, 95% CI: 1.19 to 3.14, p = 0.047), lymphovascular invasion (HR: 1.73, 95% CI: 1.03 to 2.90, p = 0.03) and pre-operative albumin <3.5 g/dl (HR 1.71, 95% CI: 1.09 to 2.67, p = 0.02). Tumors with perineural invasion also had higher rate of lymphovascular invasion. Patients with low albumin level had higher proportion of T3 and T4 staging, and poorly differentiated tumors. Notably, pre-operative biliary drainage and total bilirubin were not significant predictive factors. Conclusion: Poor prognostic factors for periampullary carcinoma after PD included N2 nodal status, perineural invasion, lymphovascular invasion, positive resection margin and low albumin level. Therefore, radical surgical resection and pre-operative improvement of nutritional status should be considered.