PROGNOSTIC FACTORS FOR SURVIVAL AFTER PANCREATICODUODENECTOMY FOR PATIENTS WITH CARCINOMA OF THE PANCREATIC HEAD REGION

Background. The aim of this study was to determine prognostic factors for survival after pancreaticoduodenectomy (PD) for carcinoma of the p ancreatic head region. Methods. From 1983 to 1992. 176 patients underw ent PD for ampullary carcinoma (n = 67), distal bile duct carcinoma (n = 42), or pancreatic carcinoma (n = 67). The first choice for resecti on was subtotal PD (n = 146), but patients with a tumor-positive pancr eatic margin or a brittle pancreatic duct underwent total PD (n = 30). Results. Hospital mortality was 4.7% after subtotal PD and 20% after total PD. Overall 5-year survival was 31%. Survival after PD for ampul lary carcinoma care. (5-year, 50%) was significantly better (P < 0.001 ) than for distal bile duct carcinoma (24%) and pancreatic carcinoma ( 14%). Independent negative prognostic factors for survival (multivaria te analysis) were involved resection margins (hazard rate ratio [HRR] 4.08), major vascular involvement (HRR 2.20), distal bile duct or panc reatic origin of carcinoma (HRR 1.93), and perioperative blood transfu sion of more than 4 U (HRR 1.76). Tumor size (>2 cm), regional lymph n ode involvement, and a poor differentiation grade were overall negativ e factors in univariate analysis but not in the subgroup of ampullary carcinoma. Conclusion. Involvement of resection margins, major vascula r ingrowth, site of origin of carcinoma, and perioperative blood trans fusion were independent prognostic factors for survival after PD. Over all 5-year survival was 31%, and subtotal PD is advocated for all pati ents with a macroscopically resectable tumor in the pancreatic head re gion without major vascular involvement, even for those with larger tu mors or local lymph node metastasis. Care should be taken to limit the need for perioperative blood transfusions.