Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy

Abstract

BackgroundPancreatic cancer (PC) has the worst survival of all periampullary cancers. This may relate to histopathological differences between pancreatic cancers and other periampullary cancers. Our aim was to examine the distribution and histopathologic features of pancreatic, ampullary, biliary and duodenal cancers resected with a pancreaticoduodenectomy (PD) and to examine local trends of periampullary cancers resected with a PD.MethodsA retrospective review of PD between January 2000 and December 2012 at a public metropolitan database was performed. The institutional ethics committee approved this study.ResultsThere were 142 PDs during the study period, of which 70 cases were pre-2010 and 72 post-2010, corresponding to a recent increase in the number of cases. Of the 142 cases, 116 were for periampullary cancers. There were also proportionately more PD for PC (26/60, 43% pre-2010 vs 39/56, 70% post-2010, P = 0.005). There were 65/116 (56%) pancreatic, 29/116 (25%), ampullary, 17/116 (15%) biliary and 5/116 (4%) duodenal cancers. Nodal involvement occurred more frequently in PC (78%) compared to ampullary (59%), biliary (47%) and duodenal cancers (20%), P = 0.002. Perineural invasion was also more frequent in PC (74%) compared to ampullary (34%), biliary (59%) and duodenal cancers (20%), P = 0.002. Microvascular invasion was seen in 57% pancreatic, 38% ampullary, 41% biliary and 20% duodenal cancers, P = 0.222. Overall, clear margins (R0) were achieved in fewer PC 41/65 (63%) compared to ampullary 27/29 (93%; P = 0.003) and biliary cancers 16/17 (94%; P = 0.014).ConclusionsThis study highlights that almost half of PD was performed for cancers other than PC, mainly ampullary and biliary cancers. The volume of PD has increased in recent years with an increased proportion being for PC. PC had higher rates of nodal and perineural invasion compared to ampullary, biliary and duodenal cancers.

Incidence and comparative outcomes of periampullary cancer: A population‐based analysis demonstrating improved outcomes and increased use of adjuvant therapy from 2004 to 2012

“…Ours is the one of the earliest to study survival outcomes in patients with periampullary adenocarcinoma matched by stage and resection status. Prior studies have only reported outcomes for surgically resected periampullary tumors . Previous reports demonstrate duodenal location is associated with the best OS in resected periampullary cancers followed by ampullary, distal bile duct, and pancreatic head location in patients undergoing curative resection .…”

“…Pancreatic ductal adenocarcinoma accounts for 17% of newly diagnosed cancer cases originating from the digestive tract with approximately 53 000 cases estimated annually . The incidence of nonpancreatic periampullary adenocarcinoma is difficult to ascertain as most reports reflect the prevalence of only surgically resected cancers . Based on single institution reports among surgically resected patients, pancreas ductal adenocarcinoma accounts for 50% to 75%, distal cholangiocarcinoma and ampullary carcinoma account for 10% to 20% each, and duodenal carcinoma account for 3% to 7% of periampullary adenocarcinoma cases .…”

Advances in Molecular Pathology and Treatment of Periampullary Cancers

“…[4][5][6] Although ampullary cancers have a higher rate of potentially curative resection compared with PC with a 5-year survival of 37% to 60%, those who relapse die of tumor progression after a mean (SD) period of 10.1 (2.3) months (range, 1.0-24.1 months) from detection of recurrence. [38][39][40][41][42] These cancers unlike PCs have had far fewer dedicated trials compared with PC.…”

“…5 In an Australian series, 25% of resected PACs were ampullary cancers with ratios of 56:25:15:4. 6 The aim of this paper was to review and highlight recent advances in the genomic and molecular understanding of each PAC subtype and the advances in chemotherapeutic and molecular trials in PAC subtypes.…”

Pancreaticoduodenectomy Procedure - A Tertiary Care Centre Experience

“…[10] Chandrasegaram et al performed a retrospective review of PD between January 2000 and December 2012 at a public metropolitan database. [13] Of the 142 cases, 116 were for periampullary cancers. There were 65 (56%) pancreatic, 29 (25%), ampullary, 17 (15%) biliary and 5 (4%) duodenal cancers.…”