Scientific paper
Factors influencing survival after resection for periampullary neoplasms

https://doi.org/10.1016/S0002-9610(00)00405-0Get rights and content

Abstract

Background: The purpose of this study was to determine predictors of survival after resection for periampullary neoplasms.

Methods: Over a 15-year period, 208 patients underwent laparotomy for periampullary neoplasms. Data were analyzed to assess predictors of survival.

Results: Pathologic examination showed pancreatic cancer (n = 136; 65%), ampullary cancer (n = 28; 13%), distal common bile duct cancer (n = 10; 5%), duodenal cancer (n = 4; 2%), neuroendocrine tumor (n = 11; 5%), cystadenocarcinoma (n = 4; 2%), cystadenoma (n = 5; 2%), and other (n = 10; 5%). A total of 129 patients underwent pancreatic resection (71 Whipples, 35 total pancreatectomies, 21 distal pancreatectomies, and 2 partial pancreatectomies) whereas 79 patients were found to be unresectable and underwent palliative bypass and/or biopsy. Median survival was 20.4 months for resectable patients versus 4.5 months for unresectable patients (P <0.001). Of the 129 resected patients, factors significantly (P <0.05) favoring long-term survival on univariate analysis included well-differentiated histology, common bile duct or ampullary adenocarcinoma, early stage, tumor diameter <2 cm, negative margins, and absence of lymph node metastases, perineural, or vascular invasion. Age, sex, race, and type of procedure had no influence on survival. On multivariate analysis, only tumor differentiation appeared independently related to survival. Using Kendall’s tau analysis, tumor type and grade correlated significantly with all other predictors.

Conclusions: Of all variables studied, tumor type and poor tumor differentiation in periampullary neoplasms appear to be markers that predict a constellation of other adverse findings.

Section snippets

Patients and methods

A retrospective review of 208 patients undergoing laparotomy for presumed periampullary neoplasia at a single institution between 1983 and 1998 was carried out. Patients undergoing laparotomy for pancreatitis were excluded from the study. Charts were reviewed for patient demographics, operative, and pathologic parameters and follow-up data were obtained from tumor registry and/or clinic notes. All cases were done with residents at a teaching institution under the supervision of one attending

Patient demographics and operative variables

The patients had a median age of 63 years (range 29 to 90); 58% of patients were male and 78% were white. Of the 208 patients who underwent laparotomy for presumed periampullary carcinoma, 79 were found to be unresectable and underwent palliative bypass or biopsy only. The remaining 129 patients underwent pancreatic resection consisting of the Whipple procedure in 71 (55%), total pancreatectomy in 35 (27%), distal pancreatectomy in 21 (16%), and partial pancreatectomy in 2 (1%). The median

Comments

We have used the term “periampullary” with the full acknowledgement that it covers a wide array of histologic tumor types from several adjoining anatomic structures. The justification for the continued usage of the term is explained in Table I. The exact tumor type and site of origin cannot often be detected preoperatively and even intraoperatively. The full answer is often obtained only after careful pathologic examination of the resected specimen. Thus, only about 75% of periampullary cancers

Conclusion

In summary, although many patients with periampullary neoplasms succumb to their disease, there is a subset of patients who will do well after pancreatectomy. These patients include those with well-differentiated histology, small tumors, negative nodes, clear margins, absence of vascular or perineural invasion, and ampullary or distal common bile duct tumors. Clearly, the most important chance to affect survival remains with earlier detection. The possibilities for earlier detection of

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