Results of Pancreaticoduodenectomy in Patients With Periampullary Adenocarcinoma

Roest, Margijske H. G. van; Gouw, Annette S.H.; Peeters, Paul; Porte, Robert J.; Slooff, Maarten J. H.; Fidler, V.; Jong, Koert P. de

doi:10.1097/sla.0b013e31817b6609

Cited by 71 publications

(18 citation statements)

References 51 publications

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“…Diverging from other papers, in which perineural invasion was strictly correlated with poorer overall long-term survival 5 , 27 , in this study, this feature was not associated with better or worse prognosis.…”

Section: Discussioncontrasting

confidence: 47%

Angiolymphatic invasion as a prognostic fator in resected N0 pancreatic adenocarcinoma

Almeida¹,

Pacheco²,

Silva³

et al. 2017

ABCD, arq. bras. cir. dig.

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Background:Pancreatic adenocarcinoma remains one of the worst digestive cancers. Surgical resection is the main target when treating a patient with curative intent. Aim:To assess angiolymphatic invasion as a prognostic factor in resected pN0 pancreatic cancer. Methods:Thirty-eight patients were submitted to pancreatoduodenectomy due to head pancreatic cancer. Tumor size, margins, lymph nodes, pTNM staging, angiolymphatic and perineural invasion were described in the pathologists' reports. Results:Most patients were female. Overall median survival was 13 months. Gemcitabine was the regimen of choice for chemotherapy in selected patients; however, it did not improve overall survival. pR0 resection had better survival compared with pR1. Within the pN0 group, survival was significantly better in patients without angiolymphatic invasion. Conclusion:Angiolymphatic invasion in N0 pancreatoduodenectomy can be demonstrated by the Hematoxylin-Eosin stain and may predict a poor prognosis factor for those patients.

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Section: Discussioncontrasting

confidence: 47%

Angiolymphatic invasion as a prognostic fator in resected N0 pancreatic adenocarcinoma

Almeida¹,

Pacheco²,

Silva³

et al. 2017

ABCD, arq. bras. cir. dig.

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“…Major determinants of survival are tumor characteristics[35], and the presence of disseminated disease[36]. Other factors like psycho-social and bio-behavioral influences[37], environmental influences, and income-related lifestyle factors may play a role in cancer pathogenesis[5,38,39].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Socioeconomic Status, Surgical Resection and Type of Hospital on Survival in Patients with Pancreatic Cancer. A Population-Based Study in The Netherlands

Roest

Geest

et al. 2016

PLoS ONE

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The influence of socioeconomic inequalities in pancreatic cancer patients and especially its effect in patients who had a resection is not known. Hospital type in which resection is performed might also influence outcome. Patients diagnosed with pancreatic cancer from 1989 to 2011 (n = 34,757) were selected from the population-based Netherlands Cancer Registry. Postal code was used to determine SES. Multivariable survival analyses using Cox regression were conducted to discriminate independent risk factors for death. Patients living in a high SES neighborhood more often underwent resection and more often were operated in a university hospital. After adjustment for clinicopathological factors, risk of dying was increased independently for patients with intermediate and low SES compared to patients with high SES. After resection, no survival difference was found among patients in the three SES groups. However, survival was better for patients treated in university hospitals compared to patients treated in non-university hospitals. Low SES was an independent risk factor for poor survival in patients with pancreatic cancer. SES was not an adverse risk factor after resection. Resection in non-university hospitals was associated with a worse prognosis.

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“…The corresponding median survival times were 15.0 months (pancreatic head), 31.9 months (ampulla of Vater), 102.0 months (distal bile duct), and 44.4 months (duodenum). [42] Pancreatic malignancies overall are associated with poor long-term prognosis. Five-year survival rates following pancreatic resection for pancreatic adenocarcinoma remain low (<20%), even in large volume institutions.…”

Section: Discussionmentioning

confidence: 99%

“…This result is also in line with previously published results for periampullary carcinomas, including a recently published series from Birmingham which reported an actuarial five year survival of 60% for ampullary carcinoma following resection. [44] An involved pancreatic resection margin is associated with poor patient outcome. [45] A recent study reported a margin of ≥1.5 mm to be associated with better outcome.…”

Section: Discussionmentioning

confidence: 99%

Impact of reconstruction methods and pathological factors on survival after pancreaticoduodenectomy

Binziad

Salem

Amira

et al. 2013

South Asian J Cancer

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Background:Surgery remains the mainstay of therapy for pancreatic head (PH) and periampullary carcinoma (PC) and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased survival. We evaluate the effects of reconstruction type, complications and pathological factors on survival and quality of life.Materials and Methods:This is a prospective study to evaluate the impact of various reconstruction methods of the pancreatic remnant after pancreaticoduodenectomy and the pathological characteristics of PC patients over 3.5 years. Patient characteristics and descriptive analysis in the three variable methods either with or without stent were compared with Chi-square test. Multivariate analysis was performed with the logistic regression analysis test and multinomial logistic regression analysis test. Survival rate was analyzed by use Kaplan-Meier test.Results:Forty-one consecutive patients with PC were enrolled. There were 23 men (56.1%) and 18 women (43.9%), with a median age of 56 years (16 to 70 years). There were 24 cases of PH cancer, eight cases of PC, four cases of distal CBD cancer and five cases of duodenal carcinoma. Nine patients underwent duct-to-mucosa pancreatico jejunostomy (PJ), 17 patients underwent telescoping pancreatico jejunostomy (PJ) and 15 patients pancreaticogastrostomy (PG). The pancreatic duct was stented in 30 patients while in 11 patients, the duct was not stented. The PJ duct-to-mucosa caused significantly less leakage, but longer operative and reconstructive times. Telescoping PJ was associated with the shortest hospital stay. There were 5 postoperative mortalities, while postoperative morbidities included pancreatic fistula-6 patients, delayed gastric emptying in-11, GI fistula-3, wound infection-12, burst abdomen-6 and pulmonary infection-2. Factors that predisposed to development of pancreatic leakage included male gender, preoperative albumin < 30g/dl, pre-operative hemoglobin < 10g/dl and non PJ-duct to mucosa type of reconstruction. The ampullary cancers presented at an earlier stage and had a better prognosis than pancreatic cancer and cholangiocarcinoma. Early stage (I and II), negative surgical margin, well and moderate differentiation and absence of lymph node involvement significantly predicted for longer survival.Conclusions:PJ duct-to-mucosa anastomosis was safe, caused least pancreatic leakage and least blood loss compared with the other methods of reconstruction and was associated with early return back to home and prolonged disease free and overall survival.

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Results of Pancreaticoduodenectomy in Patients With Periampullary Adenocarcinoma

Abstract: Perineural growth is a more important risk factor for survival than the primary site of periampullary carcinomas.

Cited by 71 publications

References 51 publications

Angiolymphatic invasion as a prognostic fator in resected N0 pancreatic adenocarcinoma

Angiolymphatic invasion as a prognostic fator in resected N0 pancreatic adenocarcinoma

The Impact of Socioeconomic Status, Surgical Resection and Type of Hospital on Survival in Patients with Pancreatic Cancer. A Population-Based Study in The Netherlands

Impact of reconstruction methods and pathological factors on survival after pancreaticoduodenectomy

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